| NPI | 1457554404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMEN MATCHAIN Medical Assistant 773-522-7240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 336010522) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2020-08-22 |