| NPI | 1619213170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW WALKER CEO 847-910-2567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036134095) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011556) |
| 208100000X Physical Medicine & Rehabilitation (Licence: IL 036112926) | |
| 208D00000X General Practice (Licence: IL 036060139) | |
| 363A00000X Physician Assistant (Licence: IL 085003927) | |
| 363L00000X Nurse Practitioner (Licence: IL 209011079) | |
| Enumeration Date | 2013-01-02 |
| Last Update Date | 2014-04-18 |