| NPI | 1508075680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA MUSIC Director, Provider Enrollment 877-892-9815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207X00000X Orthopaedic Surgery | |
| 208800000X Urology | |
| 363L00000X Nurse Practitioner (Licence: IN 28143009A) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2025-06-26 |