| NPI | 1790963544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA A BERG Office Manager 815-942-1203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: IL 036067399) |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2011-11-29 |