| NPI | 1285657379 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID TKACH CEO 217-545-7578 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207SG0201X Medical Genetics Clinical Genetics (M.D.) |
| 2080P0006X Pediatrics Developmental - Behavioral Pediatrics | |
| 2080P0206X Pediatrics Pediatric Gastroenterology | |
| 2080P0208X Pediatrics Pediatric Infectious Diseases | |
| 2080P0210X Pediatrics Pediatric Nephrology | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2022-07-21 |