| NPI | 1104632546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY GRECO Payer Enrollment Manager 223-341-8516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology |
| Enumeration Date | 2024-12-10 |
| Last Update Date | 2025-07-31 |