| NPI | 1801209127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE R FANCHER Owner 847-615-2200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: IL 036094339) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2014-08-22 |