| NPI | 1104925163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN JOYCE Credentialing Supervisor 331-216-1163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: IL 042618498) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2025-03-07 |