| NPI | 1124055009 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY DEGROOT President/CEO 517-279-5489 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 120010) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 120010) |
| 207R00000X Internal Medicine (Licence: MI 120010) | |
| 213E00000X Podiatrist | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| 213ES0131X Podiatrist, Foot Surgery | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2018-07-16 |