| NPI | 1316997422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARMAINE WARDENA Administrator 313-381-5674 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI KS039208) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI RC066966) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2020-08-22 |