| NPI | 1992951123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICAH OAKLEY Physician Assistant 618-993-3300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 085-003043) |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2008-08-07 |