| NPI | 1528384567 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | J WESLEY COOK Owner 773-404-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 36080259) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: IL 336043254) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2010-04-15 |