| NPI | 1538056163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY GRECO Manager Payor Enrollment 223-341-8516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| Enumeration Date | 2025-06-18 |
| Last Update Date | 2025-06-18 |