| NPI | 1770507295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN J DISANTI Officer 815-633-4100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 036067911) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036096167) |
| 208D00000X General Practice (Licence: IL 036066772) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2024-02-13 |