| NPI | 1235109745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY DALE HOUSTON Office Manager 847-234-4310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 042-000369) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: IL 042-000369) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2010-08-31 |