| NPI | 1639482235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIKITA TAVKAR Manager 847-850-5882 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036074991) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: IL 036074991) |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: IL 036074991) | |
| 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IL 036074991) | |
| 111N00000X Chiropractor (Licence: IL 038010683) | |
| Enumeration Date | 2010-07-23 |
| Last Update Date | 2015-04-03 |