| NPI | 1083971626 |
|---|---|
| Doing Business As | INTERNAL MEDICINE AT CEDAR LAKE |
| Entity Type | Organization |
| Authorized Contact | JENNIFER L JACKSON Sr. Dir Prov Enroll Onboarding 877-892-9815 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2022-01-24 |