Park, Samuel
Park, Samuel is an individual health care provider with primary practice located at 1400 Charles St , Rockford IL 61104-2224. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology, which is considered as his primary health care specialty. Park, Samuel can be contacted via phone (815) 489-4267.Contact Information
Primary practice address
1400 Charles St
Rockford IL 61104-2224
Phone: (815) 489-4267
Fax: (815) 966-3967
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | 036063669 | Illinois |
Profile Details
| NPI number | 1720050495 |
|---|---|
| LBN Legal business name | Park, Samuel |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 6th, 2006 |
| Last updated | Jul 18th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1720050495 | NPPES |
| Illinois | MEDICAID | 036063669 |
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