| 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 |