| NPI | 1154401669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATANYA CASTILE Payer Relations 847-544-5939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QL0400X |
| Additional Taxonomies | 208800000X Urology |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2022-11-15 |