| NPI | 1518360916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS TIETJEN Manager 231-439-5491 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: MI 4301077247) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2014-12-12 |