| NPI | 1740600246 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DHIRENDRA KUMAR Medical Director 224-766-9400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207P00000X Emergency Medicine |
| 261QU0200X Clinic/Center Urgent Care | |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant Medical | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2014-04-23 |