| NPI | 1043468440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY JENKINS Office Manager 312-953-0547 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036094988) |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2008-08-28 |