NPI | 1215388632 |
---|---|
Entity Type | Organization |
Authorized Contact | LESLIE A MICHAUD Owner 913-808-5275 |
Organization Subpart ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: KS 04-36559) |
Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: KS 04-36559) |
Enumeration Date | 2016-06-27 |
Last Update Date | 2017-03-23 |