| NPI | 1659815074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KONSTANTINS KOCIASVILI Medical Doctor 773-507-7434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: IL 036135325) |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2023-01-13 |