| NPI | 1609045863 |
|---|---|
| Doing Business As | PHYSICIAN SPECIALTY |
| Entity Type | Organization |
| Authorized Contact | DOROTHY CHERYL ERINS Credentialing Specialist 269-244-5256 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: IL 000007296) |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2021-01-27 |