| NPI | 1124763479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADRIENNE MICHELE SCHUPBACH Owner/Physician 309-533-8899 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Enumeration Date | 2022-05-02 |
| Last Update Date | 2024-12-17 |