| NPI | 1073679411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE P EDGCOMB President 815-397-7900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 042000060) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: IL 04200060) |
| 2086S0129X Surgery, Vascular Surgery (Licence: IL 042000060) | |
| 208C00000X Colon & Rectal Surgery (Licence: IL 042000060) | |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: IL 042000060) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2020-08-22 |