| NPI | 1972624799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARGIE CALLAHAN Practice Manager 773-631-0566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036100881) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036095721) |
| 207Q00000X Family Medicine (Licence: IL 036133839) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2015-02-20 |