| NPI | 1134489453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW WALKER CEO 847-910-2567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 036112926) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011342) |
| 171100000X Acupuncturist (Licence: IL 198001014) | |
| 363A00000X Physician Assistant (Licence: IL 085003927) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 041204674) | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2013-05-01 |