| NPI | 1467535211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M RUCKER Provider Enrollment Manager 517-355-8462 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2018-02-08 |