| NPI | 1003115577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN ANDREW HICKNER Registered Agent 616-633-8628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WY TL1524) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2011-03-29 |