| NPI | 1740491745 |
|---|---|
| Other Name | JAMES MELVIN SEVERSON |
| Entity Type | Organization |
| Authorized Contact | JAMES MELVIN SEVERSON Medical Doctor 815-399-5268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 036067207) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2012-03-27 |