| NPI | 1033433453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI RAE SEVERSON Account Manager 815-941-1317 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2010-03-15 |
| Last Update Date | 2015-01-29 |