| NPI | 1861930984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE L RIOS Vice President 630-388-9033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| 208200000X Plastic Surgery (Licence: IL 036109103) | |
| 332900000X Non-Pharmacy Dispensing Site | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2024-05-15 |