| NPI | 1235634577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON WHITESIDE Manager 312-796-9483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: IL 203001978) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2024-01-10 |