| NPI | 1114529237 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE CHRISTINE MIRANDA Practice Manager 765-838-2310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 261QM2500X Clinic/Center Medical Specialty |
| Enumeration Date | 2020-11-13 |
| Last Update Date | 2021-02-26 |