| NPI | 1134422363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALIK FUQUA Owner 248-968-6899 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2013-12-20 |