| NPI | 1396703021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE BLAKE Medical Director 773-233-2408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036093241) |
| Additional Taxonomies | 261QA0600X Clinic/Center, Adult Day Care |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2020-08-22 |