| NPI | 1366534232 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIVKUMAR PRABHU Owner 313-832-6125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: MI SP055656) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2020-08-22 |