| NPI | 1386783199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC ANDERSON Administrator 815-942-4875 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2009-01-21 |