| NPI | 1205541976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN WALDO Owner 773-520-1950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-01-17 |
| Last Update Date | 2023-01-17 |