| NPI | 1366798373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUPAK SOOKKASIKON Not Applicable 248-885-8211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301080609) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301083253) |
| 261QU0200X Clinic/Center, Urgent Care | |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2022-10-14 |