| NPI | 1053648220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KANDI LINN PRESTON Billing Specialist 989-463-0957 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2019-06-06 |