| NPI | 1376894501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCEE A BRUMMEL Executive Director 630-499-2404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| 207RS0010X Internal Medicine, Sports Medicine | |
| 2083S0010X Preventive Medicine, Sports Medicine | |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2018-02-21 |