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 |