NPI | 1881589703 |
---|---|
Entity Type | Organization |
Authorized Contact | LORENA THOMAS Credentialing Manager 815-254-1761 |
Organization Subpart ? | No |
Primary Taxonomy | 2086S0129X |
Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) |
Enumeration Date | 2025-06-11 |
Last Update Date | 2025-06-11 |