| NPI | 1124721717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL DISTEFANO Operations Manager 380-400-9215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism |
| 208D00000X General Practice | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2023-03-23 |
| Last Update Date | 2023-03-23 |