| NPI | 1144735648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITTANEY BURDETTE Credentialing Specialist 313-293-6476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2017-12-06 |
| Last Update Date | 2017-12-06 |