| NPI | 1790954725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK AMBROSE Physician Asst. / Surgeon Asst. 708-721-1463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085000830) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2008-02-25 |