| NPI | 1336890482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDSAY BARKER Enrollment Specialist 734-373-0849 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2022-12-16 |