=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871679217
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD C SOULE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1609 SHERMAN AVE SUITE 210
-----------------------------------------------------
City | EVANSTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60201-3753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-275-8825
-----------------------------------------------------
Fax | 302-371-6527
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1114 HARVARD TER
-----------------------------------------------------
City | EVANSTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60202-3309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-275-8825
-----------------------------------------------------
Fax | 302-371-6527
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------