| NPI | 1477694198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE SIDNEY WRIGHT Physician 773-777-2620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036065761) |
| Additional Taxonomies | 2083X0100X Preventive Medicine Occupational Medicine (Licence: IL 035065761) |
| 332900000X Non-Pharmacy Dispensing Site (Licence: IL AW2016651) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2009-04-27 |