| NPI | 1093596652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADRIENNE SCHUPBACH Md/Practice Owner 309-533-7070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Enumeration Date | 2023-10-10 |
| Last Update Date | 2023-10-25 |