| NPI | 1790131936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VLAD FERDKOFF Owner 847-877-6858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 019024754) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2016-05-06 |