| NPI | 1154744597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DON D BOUCHARD President 269-279-9332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 5101011443) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801094934) |
| 176B00000X Midwife | |
| 207Q00000X Family Medicine | |
| 251B00000X Case Management | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MI 6801094934) | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 363AM0700X Physician Assistant, Medical (Licence: MI 5601002054) | |
| Enumeration Date | 2014-01-21 |
| Last Update Date | 2021-07-19 |