| NPI | 1710931670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINA M PEUGH Executive Director 309-674-7546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology |
| 208200000X Plastic Surgery | |
| 208600000X Surgery | |
| 207ND0900X Dermatology, Dermatopathology | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery | |
| 207NS0135X Dermatology, Procedural Dermatology | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2008-04-08 |