| NPI | 1326612763 |
|---|---|
| Former Legal Business Name | PROACTIVE MD |
| Entity Type | Organization |
| Authorized Contact | MARK ALLEN KEMBLE Cmo 864-501-0751 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2025-04-10 |