| NPI | 1164528527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANA COOPER Administrator 734-528-1405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MI 81-6818) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MI 4704111201) |
| 367H00000X Anesthesiologist Assistant (Licence: MI 4704204265) | |
| 367H00000X Anesthesiologist Assistant (Licence: MI 4704118315) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2015-08-25 |