| NPI | 1396864849 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL P GUSHO CFO Se Mi Region 248-858-6174 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2017-10-05 |