| NPI | 1821288945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNETTE WELLS Office Administrator 815-937-2044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036068108) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036068108) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2009-12-23 |