| NPI | 1922295328 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY MACMURCHY Contracting And Credentialing 815-484-9900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IL 036104814) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: IL 036104814) |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: IL 036104814) | |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2007-11-08 |