| NPI | 1093888216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SRINIVAS B MUKKAMALA Medical Doctor 810-244-8400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MI 4301075543) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2018-08-28 |