| NPI | 1124323597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE A JERNIGAN COO/CFO 734-347-1462 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MI 4301089099) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: MI 4301039079) |
| 261QP2300X Clinic/Center, Primary Care (Licence: MI 4307095750) | |
| 363A00000X Physician Assistant (Licence: MI 5601004426) | |
| Enumeration Date | 2011-01-17 |
| Last Update Date | 2015-03-04 |