| NPI | 1255427209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY MARIE MONTECILLO Practice Manager 586-228-0400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101009509) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2024-06-03 |