| NPI | 1235012162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY J BAUGHEY Director Of Credentialing 267-981-6519 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208000000X Pediatrics | |
| Enumeration Date | 2025-07-29 |
| Last Update Date | 2025-07-29 |