| NPI | 1487394888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARRETT MICHAEL LEATHEM Do Owner 860-670-2412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 111N00000X Chiropractor |
| 207L00000X Anesthesiology | |
| 207LP2900X Anesthesiology Pain Medicine | |
| 207RI0011X Internal Medicine Interventional Cardiology | |
| 207X00000X Orthopaedic Surgery | |
| 208VP0014X Pain Medicine Interventional Pain Medicine | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2022-04-01 |