| NPI | 1477724425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRODYOT K MITRA Owner 815-344-0621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036052608) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036062584) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2013-10-23 |