NPI | 1184498628 |
---|---|
Doing Business As | PROACTIVE MD |
Entity Type | Organization |
Authorized Contact | MARK ALLEN KEMBLE Cmo 864-501-0751 |
Organization Subpart ? | No |
Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
Enumeration Date | 2023-11-14 |
Last Update Date | 2025-04-03 |