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 |