| NPI | 1306489893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD E ROLAND Authorized Official 815-401-5341 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 163W00000X Registered Nurse |
| 207LP2900X Anesthesiology, Pain Medicine | |
| 207T00000X Neurological Surgery | |
| Enumeration Date | 2019-10-28 |
| Last Update Date | 2019-10-28 |