| NPI | 1326481623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAREK HADLA Md 313-562-4700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MI 4301065806) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MI 4301095806) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2015-05-15 |