| NPI | 1730906348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLIN BLANE AO 312-820-1138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2024-11-18 |