| NPI | 1932480605 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE ZYDEK Director Of Finance 815-748-2986 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 208800000X Urology | |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2018-04-16 |