| NPI | 1609224492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEN WEBER Credentialing Coordinator 224-231-4363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: IL 036105360) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 036105360) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: IL 036105360) | |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2016-06-02 |