| NPI | 1245939818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUIS LAPIANA Chief Operating Officer 313-909-4463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2023-03-02 |
| Last Update Date | 2023-03-02 |