| NPI | 1295917524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH J MOODY D O Owner 989-893-9705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MI 5101008328) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101008328) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2007-11-28 |