| NPI | 1972215390 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BORIS GUREVICH Officer 847-226-5503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2022-12-16 |
| Last Update Date | 2023-01-09 |