| NPI | 1073978243 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERISE ELMORE Medical Billing Manager 219-840-2297 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036047008) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036047008) |
| Enumeration Date | 2015-12-15 |
| Last Update Date | 2015-12-15 |