| NPI | 1417657321 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY SCOTT YOUSE Chief Medical Director 217-729-7650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| 207ND0900X Dermatology, Dermatopathology | |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2023-03-08 |