| NPI | 1326691593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE BLUE Credentialing Sr. Manager 773-292-4800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RH0002X Internal Medicine, Hospice and Palliative Medicine |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2024-07-15 |