| NPI | 1205946662 |
|---|---|
| Doing Business As | HISTORIC NORTHSIDE FAMILY PRACTICE |
| Entity Type | Organization |
| Authorized Contact | RHODA M ROBINSON Office Manager 269-969-6040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301044388) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101013731) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2009-05-05 |