| NPI | 1659690022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN C. HEADLEY General Surgeon 708-484-0621 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 036114720) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 036118355) |
| 261QM2500X Clinic/Center, Medical Specialty | |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2023-11-01 |