NPI | 1811584030 |
---|---|
Entity Type | Organization |
Authorized Contact | GRACE BLUE Credentialing Sr. Manager 773-292-4800 |
Organization Subpart ? | No |
Primary Taxonomy | 207R00000X Internal Medicine |
Additional Taxonomies | 207RH0002X Internal Medicine, Hospice and Palliative Medicine |
207Q00000X Family Medicine | |
207QH0002X Family Medicine, Hospice and Palliative Medicine | |
Enumeration Date | 2020-12-22 |
Last Update Date | 2024-01-30 |