| NPI | 1396464657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIBRAN NASEER Owner 309-319-2393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2025-03-25 |