| NPI | 1073230876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT GREEN Owner 248-862-5311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine |
| 213E00000X Podiatrist | |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2023-06-12 |