| NPI | 1750154027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NAHREN KHOSHABA Authorized Official 224-633-8447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 3336C0002X Pharmacy, Clinic Pharmacy | |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2025-10-21 |