| NPI | 1386524767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MADISON TEEL Credentialing Assistant 442-325-8753 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 261QU0200X Clinic/Center Urgent Care | |
| Enumeration Date | 2025-09-05 |
| Last Update Date | 2025-09-05 |