| NPI | 1003268202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA JEAN CONQUEST Practice Manager 231-935-0340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 5101017642) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2016-07-12 |