| NPI | 1417547134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SABET M SIDDIQUI President/CEO 815-519-1788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0002X Clinic/Center Emergency Care |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 251E00000X Home Health | |
| 261QC1500X Clinic/Center Community Health | |
| 261QE0700X Clinic/Center End-Stage Renal Disease (ESRD) Treatment | |
| 261QE0800X Clinic/Center Endoscopy | |
| 261QH0100X Clinic/Center Health Service | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QP2300X Clinic/Center Primary Care | |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2021-01-26 |