| NPI | 1891386116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY JOAN MACKNISKAS Sr Director Of Net Revenue 773-213-0776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2021-01-29 |
| Last Update Date | 2021-01-29 |