| NPI | 1972857613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA BUGSALEWICZ Billing Manager 773-558-2737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036039250) |
| Enumeration Date | 2012-11-02 |
| Last Update Date | 2012-11-02 |