| NPI | 1720388267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORENA THOMAS Credentialing Manager 815-254-1761 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0053733) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: MD D0053733) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2010-11-01 |
| Last Update Date | 2024-05-30 |