| NPI | 1295122539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MUMTAZ SIDDIQUE Doctor 847-931-9744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019022632) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2015-04-24 |