| NPI | 1700538121 |
|---|---|
| Former Legal Business Name | PROACTIVE MD IL SC |
| Other Name | PROACTIVE MD |
| Entity Type | Organization |
| Authorized Contact | JAN HOPKINS Assoc. Mgr Of Ops 864-501-0751 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2022-01-26 |
| Last Update Date | 2022-01-26 |