| NPI | 1831178573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY F FULLENKAMP President 309-762-9711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: IL 036-076753) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: IL 036076753) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2007-10-29 |