| NPI | 1114035615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONSTANCE L FREDERICKS Manager 815-744-5550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: IL 042.005614) |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2018-12-28 |