| NPI | 1730906348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLIN BLANE AO 312-820-1126 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 3336C0002X Pharmacy, Clinic Pharmacy | |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2025-10-14 |