| NPI | 1053075358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARC VANDER VLIET Owner 313-574-7445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2021-10-24 |
| Last Update Date | 2022-07-07 |