| NPI | 1720526890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA SHEPHERD Office Manager 312-782-9153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 036.056894) |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2019-08-12 |