| NPI | 1982140042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIDA YOUSEF Director 708-745-3499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 036124580) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2017-01-13 |
| Last Update Date | 2024-12-27 |