NPI | 1174198568 |
---|---|
Entity Type | Organization |
Authorized Contact | LINDSAY BARKER Credentialing Manager 734-373-0849 |
Organization Subpart ? | No |
Primary Taxonomy | 208D00000X General Practice |
Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
Enumeration Date | 2021-05-26 |
Last Update Date | 2024-07-24 |