| NPI | 1790945103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY J TISSIER Member 618-628-1717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: IL 036097979) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036097979) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2008-06-10 |