| NPI | 1104019983 |
|---|---|
| Doing Business As | PORTAGE LAKES INTERNAL MEDICINE (DME) |
| Entity Type | Organization |
| Authorized Contact | DEBBIE BREWER Director Of Provider Enrollment 615-465-7000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2007-08-24 |