Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 036075758 | IL |
NPI | 1134213051 |
---|---|
Provider Name | Timothy Voirin |
First Address | Pekin, IL 61554-4936 |
Second Address | Pekin, IL 61554-4936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 13/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036075758 | (05) | IL |
E19285 | (02) |