| NPI | 1043670805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY GRECO Payer Enrollment Manager 223-341-8516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2025-07-31 |