| NPI | 1063637684 |
|---|---|
| Other Name | PORTAGE CRAGIN OUTPATIENT |
| Entity Type | Organization |
| Authorized Contact | MARK STUTRUD President 847-635-4600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 1041C0700X Social Worker, Clinical | |
| 207Q00000X Family Medicine | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2019-12-31 |