| NPI | 1376436220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY THEUS Nurse Practitioner 847-624-6907 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261Q00000X Clinic/Center | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QP2300X Clinic/Center, Primary Care | |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2025-05-30 |
| Last Update Date | 2025-08-25 |