| NPI | 1154556843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SRIVALLI VEGI Owner 636-579-6778 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine (Licence: IL 036121501) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036121501) |
| Enumeration Date | 2009-05-25 |
| Last Update Date | 2010-04-15 |