| NPI | 1417270018 |
|---|---|
| Doing Business As | NONE |
| Entity Type | Organization |
| Authorized Contact | ALEX Q MATAVERDE Physician 313-336-3180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301031512) |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2010-05-19 |