| NPI | 1699833079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE CORWIN Authorized Official 815-436-8831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2008-05-23 |