| NPI | 1114362456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AKAVUT SUESAKUL Owner 312-532-7472 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2013-10-15 |