| NPI | 1487152104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HARRY HOSTETLER Owner 262-875-5070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine |
| 207R00000X Internal Medicine | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| Enumeration Date | 2018-01-28 |
| Last Update Date | 2021-06-14 |