| NPI | 1568242055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITT MICHAEL BORDEN Owner 708-846-8888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207T00000X Neurological Surgery | |
| 208D00000X General Practice | |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2023-10-02 |