| NPI | 1700063179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HARRY BROCKUS CEO 618-395-7340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: IL 036050750) |
| Additional Taxonomies | 208800000X Urology (Licence: IL 036119328) |
| 363L00000X Nurse Practitioner (Licence: IL 209004125) | |
| 208600000X Surgery (Licence: IL 036060342) | |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2020-12-22 |