| NPI | 1073592119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUSTIN BRUCE FRAZIER CFO 815-285-5521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207RI0011X Internal Medicine, Interventional Cardiology |
| 207V00000X Obstetrics & Gynecology | |
| 207W00000X Ophthalmology | |
| 207X00000X Orthopaedic Surgery | |
| 207Y00000X Otolaryngology | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology | |
| 208000000X Pediatrics | |
| 207L00000X Anesthesiology | |
| 207P00000X Emergency Medicine | |
| 207QS0010X Family Medicine, Sports Medicine | |
| 207R00000X Internal Medicine | |
| 207RC0000X Internal Medicine, Cardiovascular Disease | |
| 207RG0100X Internal Medicine, Gastroenterology | |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2022-12-28 |