| NPI | 1689904500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK CHAO Corp. Secretary 847-657-8588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036107878) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: IL 036107878) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: IL 036107878) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: IL 036107878) | |
| Enumeration Date | 2009-12-29 |
| Last Update Date | 2010-04-28 |