NPI | 1023281722 |
---|---|
Entity Type | Organization |
Authorized Contact | KIMBERLY GRAY WHITE Owner/Doctor 773-821-4600 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 036099296) |
Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: IL 036106823x) |
Enumeration Date | 2008-04-02 |
Last Update Date | 2008-04-03 |