| NPI | 1700754751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORENA THOMAS Cred Manager 815-254-1761 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| Enumeration Date | 2025-10-29 |
| Last Update Date | 2025-10-29 |