| NPI | 1083686083 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE JOHNSON Credentialing Manager 586-710-2307 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2025-05-22 |