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 |