| NPI | 1154912202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY OWENS Director , Finance 815-300-7106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207T00000X Neurological Surgery |
| 208600000X Surgery | |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2021-02-01 |