| NPI | 1477385599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUTA KHAN Medical Director 224-407-2140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2024-08-16 |
| Last Update Date | 2024-09-25 |