| NPI | 1730896390 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERA BOUTROS Physician Owner 224-526-8346 |
| Organization Subpart ? | No |
| Primary Taxonomy | 202K00000X Phlebology |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2022-11-03 |
| Last Update Date | 2024-11-22 |