| NPI | 1881890333 |
|---|---|
| Doing Business As | PROVIDA FAMILY MEDICINE |
| Entity Type | Organization |
| Authorized Contact | LUIS I SALAZAR Authorized Official 847-548-2200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 042616958) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2024-01-31 |