| NPI | 1962481861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH BROCKMAN CEO 309-762-3621 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: IL 060006850) |
| Additional Taxonomies | 163WM0705X Registered Nurse Medical-Surgical |
| 207QS0010X Family Medicine Sports Medicine | |
| 207RR0500X Internal Medicine Rheumatology | |
| 207XS0106X Orthopaedic Surgery Hand Surgery | |
| 2084N0400X Psychiatry & Neurology Neurology | |
| 2084N0600X Psychiatry & Neurology Clinical Neurophysiology | |
| 213ES0103X Podiatrist Foot & Ankle Surgery | |
| 246ZS0410X Specialist/Technologist, Other Surgical Technologist | |
| 247200000X Technician, Other | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| 363AM0700X Physician Assistant Medical | |
| 363AS0400X Physician Assistant Surgical | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2024-04-29 |