| NPI | 1578665907 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD ERIC SAM Sole Manager/Physician 708-422-7758 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036094623) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2015-08-03 |