| NPI | 1760262539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHENITA STAGGERS Vice President 219-218-9906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine |
| Enumeration Date | 2023-09-29 |
| Last Update Date | 2023-09-29 |