| NPI | 1912195595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL BABICH Practice Manager 217-876-6890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IL 036-09961) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: IL 036-099961) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2007-10-10 |