| NPI | 1447643689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEIDRE WELLER Director Of Finance 231-924-1380 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2015-03-12 |