| NPI | 1508982299 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY A RISEMAN Officer 217-629-8711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036076506) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036076506) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2007-10-31 |