| NPI | 1457367070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGIA M AMIEWALAN Business Manager 217-422-0560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: IL 036112019) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: IL 036112019) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2009-08-14 |