| NPI | 1538245832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NORMITA M LICUDINE Secretary 773-379-4348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036051696) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036046217) |
| Enumeration Date | 2006-10-29 |
| Last Update Date | 2010-04-13 |