| NPI | 1073621835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINIC A CUSUMANO Owner 586-573-6669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301407063) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301047282) |
| 208600000X Surgery (Licence: MI 4301049997) | |
| 363A00000X Physician Assistant (Licence: MI 5601003884) | |
| 363A00000X Physician Assistant (Licence: MI 5601003978) | |
| 363A00000X Physician Assistant (Licence: MI 5601003403) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2014-11-10 |