| NPI | 1124362306 |
|---|---|
| Doing Business As | CRYSTAL LAKE CLINIC |
| Entity Type | Organization |
| Authorized Contact | SMRITI KHARE President, Children's Physician Grp 414-266-7615 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology |
| Enumeration Date | 2012-11-12 |
| Last Update Date | 2012-11-12 |