| NPI | 1871860940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD H WAGNER Physician 847-842-0771 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: IL 036085205) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2011-11-17 |