| NPI | 1154552016 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERRY L BAKOVICH Office Manger 847-524-1700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 046007080) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: IL 047935456) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2010-08-26 |