| NPI | 1376226159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE YESH Biller 269-651-7824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2023-08-16 |