| NPI | 1285022442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE DENSLEY Owner 313-699-5400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301039079) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704265133) |
| Enumeration Date | 2014-12-22 |
| Last Update Date | 2014-12-22 |