| NPI | 1699102442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KASEY LAZ ABANONU Owner 312-823-6126 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207RC0000X Internal Medicine Cardiovascular Disease | |
| 2084N0400X Psychiatry & Neurology Neurology | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 208VP0000X Pain Medicine Pain Medicine | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2013-10-10 |
| Last Update Date | 2022-03-17 |