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NPI Code Detail

MEDICARE: THORDUR SKULI AGUSTSSON MD

MEDICARE: THORDUR SKULI AGUSTSSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician036-071878IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790895977
Entity Type Code : Individual
Provider Name (Legal Business Name) : THORDUR SKULI AGUSTSSON MD
Provider Business Mailing Address
First Line : 5970 CHURCHVIEW DR
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-2574
Country : US
Telephone Number : 815-971-2000
Fax Number :
Provider Business Practice Location Address
First Line : 5970 CHURCHVIEW DR
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-2574
Country : US
Telephone Number : 815-971-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 11/09/2007

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