| NPI | 1124223763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH J LIESEN Medical Doctor 630-584-8900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036077277) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2014-01-17 |