Individual
KIM TREVIRANUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 E MILLER RD, STERLING, IL 61081-1252
(815) 625-4790
Mailing address
101 E MILLER RD, STERLING, IL 61081-1252
(815) 625-4790
Taxonomy
Speciality
Code
Description
License number
State
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
036061910
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036061910
—
IL
01
—
091400
HEALTH ALLIANCE MEDICAL
IL
01
—
9815737
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/16/2006
Last updated
11/13/2018
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