| NPI | 1053540542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KWABENA APPIAH Manager 708-229-2845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IL 40429a) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: IL 124583576739574124) |
| 302R00000X Health Maintenance Organization (Licence: IL 40429a) | |
| 305R00000X Preferred Provider Organization (Licence: IL 40429a) | |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2009-07-07 |