| NPI | 1215221353 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEIDRE WELLER Controller 269-945-1212 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2016-04-22 |