NPI Code Detail JSON Logo

1295001907 NPI number — ELLEN THERESE PARKER MD

NPI Number: 1295001907
Health Care Provider/Practitioner: ELLEN THERESE PARKER MD

Information about “1295001907” NPI (ELLEN THERESE PARKER MD) exists in 1295001907 in HTML format HTML  |  1295001907 in plain Text format TXT  |  1295001907 in PDF (Portable Document Format) PDF  |  1295001907 in an XML format XML  formats.

NPI Number : 1295001907 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1295001907",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PARKER",
    "FirstName": "ELLEN",
    "MiddleName": "THERESE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KLOCKER",
    "OtherFirstName": "ELLEN",
    "OtherMiddleName": "THERESE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "7005 NORTH AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OAK PARK",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60302-1001",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "708-327-1410",
    "MailingAddressFaxNumber": "708-383-8932",
    "FirstLinePracticeLocationAddress": "300 N YORK ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ELMHURST",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60126-2377",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "708-327-7030",
    "PracticeLocationAddressFaxNumber": "630-833-8834",
    "EnumerationDate": "03/27/2012",
    "LastUpdateDate": "04/30/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208000000X",
          "TaxonomyName": "Pediatrics Physician",
          "LicenseNumber": "036137516",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "036137516",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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