| NPI | 1740840404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE ELMER Manager, Credentialing And Risk Man 815-381-7431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Enumeration Date | 2019-06-15 |
| Last Update Date | 2019-09-04 |