| NPI | 1164012019 |
|---|---|
| Doing Business As | ITHACA FAMILY PRACTICE |
| Entity Type | Organization |
| Authorized Contact | DONALD G PROUTY Owner 989-330-1492 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2021-01-25 |
| Last Update Date | 2021-02-05 |