| NPI | 1912030305 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSHMA M RAGHAVENDRA Family Physician 708-756-1135 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 036-115471) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2020-08-22 |