| NPI | 1104419753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESIREE CUNNINGHAM Nurse Pracititioner 773-616-5330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2021-02-15 |
| Last Update Date | 2021-11-02 |