| NPI | 1235377052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TABATHA LEANNE STAGE Billing Manager 248-853-2009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301081098) |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2009-02-02 |