| NPI | 1396824207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY RATOWSKI Director Provider Affairs 313-874-4806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 830190) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2024-08-23 |