| NPI | 1841590163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA CASEY Practice Manager 312-929-4492 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036078254) |
| Enumeration Date | 2010-11-03 |
| Last Update Date | 2012-03-07 |