| NPI | 1518354745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY M HEFFERON Director 248-230-1780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2015-10-15 |