| NPI | 1013077619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER SMITH Credentialing Manager 815-965-8505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2011-12-06 |