| NPI | 1962457614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GANAPATHI GOTTUMUKKALA Sole Proprietor 708-614-0893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-074987) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2009-11-25 |