| NPI | 1760272538 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY GRECO Manager Payer Enrollment 223-341-8516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease |
| Enumeration Date | 2025-05-07 |
| Last Update Date | 2025-05-07 |