| NPI | 1194487850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUDRA FICKEN Sr. Rcm Manager 734-373-0588 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2021-10-11 |
| Last Update Date | 2026-01-23 |