Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 041.369776 | IL |
NPI | 1003445099 |
---|---|
Provider Name | Timtim Lam |
First Address | Champaign, IL 61822-8570 |
Second Address | Urbana, IL 61801-2529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2020 |
Last Update Date | 02/04/2020 |