| NPI | 1306969522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVY BRANTLEY Office Manager 312-908-2928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: IL 036092949) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: IL 036092949) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2008-04-20 |