| NPI | 1962689307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDI D GRAHAM Practice Plan Administrator 217-479-5663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 208600000X Surgery | |
| 207R00000X Internal Medicine | |
| 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: IL 036048526) | |
| 207Y00000X Otolaryngology (Licence: IL 036057937) | |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine | |
| 231H00000X Audiologist | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2018-03-21 |