| NPI | 1902989379 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH TUAN President 217-877-2088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: IL 036-109943) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 036-109858) |
| Enumeration Date | 2006-10-22 |
| Last Update Date | 2015-04-21 |