| NPI | 1164897427 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORENA THOMAS Credentialing Manager 815-254-1761 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2015-12-11 |
| Last Update Date | 2024-05-30 |