| NPI | 1114324969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IAN JOSHUA TAROCKOFF Vice President 734-542-5512 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 207Q00000X Family Medicine | |
| 207RC0000X Internal Medicine Cardiovascular Disease | |
| 208VP0014X Pain Medicine Interventional Pain Medicine | |
| 213E00000X Podiatrist | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2021-01-28 |