| NPI | 1043067036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRANCE SLAVIN Regional Director Of Reimbursement 734-343-3320 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2024-05-07 |