| NPI | 1740512961 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRILL K. HAWS Medical Director 847-549-1424 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: IL 036073100) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: IL 036073100) |
| 261Q00000X Clinic/Center | |
| 261QM2500X Clinic/Center, Medical Specialty | |
| Enumeration Date | 2010-02-14 |
| Last Update Date | 2021-02-03 |