| NPI | 1083433130 |
|---|---|
| Doing Business As | PROACTIVE MD PERCIVAL |
| Entity Type | Organization |
| Authorized Contact | JODY ADDAIR Clinical Ops Project COO Rdinator 317-556-0017 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2024-10-07 |
| Last Update Date | 2024-11-22 |