| NPI | 1497719108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | A. GARY MULLER Chief Executive Officer 906-225-4821 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 030113) |
| 2080P0205X Pediatrics Pediatric Endocrinology (Licence: MI 050876) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 079600) | |
| 363A00000X Physician Assistant (Licence: MI 5601004570) | |
| 207QS0010X Family Medicine Sports Medicine | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2012-05-17 |