| NPI | 1124441258 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREY LUTSKOVSKY President 248-480-0895 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 5101016687) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101016687) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MI 5101016687) | |
| 207R00000X Internal Medicine (Licence: MI 5101016687) | |
| 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: MI 5101016687) | |
| 208D00000X General Practice | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: MI 5101016687) | |
| Enumeration Date | 2014-01-24 |
| Last Update Date | 2023-02-14 |