| NPI | 1154648418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHALID F AHMED Sercretary 1773-581-7300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036051565) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 036055369) |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2010-10-12 |