| NPI | 1093208449 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IGOR PRUS President 414-215-4419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208000000X Pediatrics | |
| 208D00000X General Practice | |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2018-06-11 |