| NPI | 1619493525 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REONEIL OLIVA Administrator 773-831-1690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208D00000X General Practice | |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2019-05-03 |