| NPI | 1841578507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN G LEE Plan Administrator 217-479-5890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036098965) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: IL 209007563) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2011-07-29 |