| NPI | 1346373065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY SHELLENBARGER Billing Supervisor 269-945-4966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301035154) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101012880) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101013049) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2008-04-23 |