| NPI | 1356805402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KANDICE KING Credentialing Specialist 847-228-3303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2019-09-20 |