| NPI | 1255683470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA JONES Credentialing 630-725-2737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 202K00000X (Licence: GA 042261) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 042261) |
| 208600000X Surgery | |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2022-02-08 |