| NPI | 1801182753 |
|---|---|
| Doing Business As | GENESIS MEMORY CLINIC, ILLINI CAMPUS |
| Entity Type | Organization |
| Authorized Contact | MARK G. ROGERS VP Of Finance / CFO 563-421-6513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2011-06-20 |