| NPI | 1548763394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEFANI MOTKAR Practice Manager 618-318-5438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2018-03-17 |