| NPI | 1477019909 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE MUDD Authorized Official 217-324-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2020-07-02 |