| NPI | 1588827208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA PAYNE Practice Manager 847-581-0110 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 36-046704) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2024-01-31 |