| NPI | 1487623344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA JEAN DOMBROWSKI Office Manager 708-331-9400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-073399) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02002162A) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2008-02-04 |