Basic Information
| Provider Information | |||||||||
| NPI: | 1174582738 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARLEY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4309 W MEDICAL CENTER DR STE A102 | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153386600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4309 W MEDICAL CENTER DR STE A102 | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153386600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036-096836 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 01050245 | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | 036096836 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 208M00000X | 036096836 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 615318701 | 01 | IL | US DEPT OF LABOR: 2001 S. CALIFORNIA AVE - LOC 1 | OTHER | 200224170 | 05 | IN | MEDICAID | 615318700 | 01 | IL | US DEPT OF LABOR: 2222 W. DIVISION ST - LOC 2 | OTHER |