| NPI | 1700987328 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE RIOS V.P. 815-744-8554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: IL 036108932) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: IL 036109103) |
| 363AM0700X Physician Assistant, Medical (Licence: IL 085002224) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2017-03-22 |