| NPI | 1821473919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTI G GROGAN Office Manager 773-721-4900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 085005506) |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2015-07-30 |