| NPI | 1356869572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLIVIA PASS Credentialing Manager 248-820-1712 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine Addiction Medicine (Licence: MI 4301055667) |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2017-09-07 |