| NPI | 1962566620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE BURSTEIN Chief Administrative Officer 773-394-5260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036048103) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036055442) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2020-08-22 |