| NPI | 1750892766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH NEWCOMER Member 309-825-0797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IL 036078056) |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2017-10-17 |