Healthcare Provider Details

I. General information

NPI: 1972501070
Provider Name (Legal Business Name): PAUL WILLIAM SPRINGBORN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 WISCONSIN AVE
RACINE WI
53403-1978
US

IV. Provider business mailing address

682 INDIAN PATH RD
GRAYSLAKE IL
60030-3517
US

V. Phone/Fax

Practice location:
  • Phone: 262-687-2206
  • Fax: 262-687-2686
Mailing address:
  • Phone: 847-543-0970
  • Fax: 262-687-2686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number12932-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: