| NPI | 1275004442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSECA WATSON Contracts And Credentialing Manager 630-572-8228 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0401X Family Medicine, Addiction Medicine | |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2020-10-08 |