| NPI | 1518379700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARRY SUMMERS Owner 708-529-0355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036125989) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036125989) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: IL 036125989) | |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2018-05-10 |