| Organization Name: | IBSEN LLC |
| NPI Number: | 1316387616 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RAFAEL PEREZ-GUERRA (PRESIDENT) |
| Mailing Address: | 16003 Executive Dr Crest Hill |
| State: | IL US |
| Postal Code: | 604030500 |
| Phone Number: | 8157442344 |
| Fax Number: | |
| NPI Enumeration Date: | 07/01/2013 |
| NPI Last Update Date: | 07/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | 036057264 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |