| NPI | 1518145176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANN CHARLES FIELDS Director 847-785-0611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2020-03-27 |