| NPI | 1396973129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN CLARK VAN WAGNEN Physician 517-787-1990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 038051) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2009-07-27 |