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 |