| NPI | 1558775502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY A HOLTZ Practice Manager 224-629-4525 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036129040) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 36103130) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2014-10-17 |