| NPI | 1164412334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID A SULLIVAN Administrative Officer 773-772-9380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036-098541) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2020-08-22 |