| NPI | 1093253668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE SHAPIRO President, CFO/Treasurer 312-940-2510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2017-02-03 |
| Last Update Date | 2022-03-04 |