Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 036061987 | IL |
NPI | 1740271808 |
---|---|
Provider Name | William G Spies |
First Address | Chicago, IL 60611-5975 |
Second Address | Chicago, IL 60611-5975 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2005 |
Last Update Date | 30/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D15337 | (02) |