| NPI | 1518419043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARISLENE DELVA Administrator 313-575-8111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine |
| 207QG0300X Family Medicine, Geriatric Medicine | |
| 207R00000X Internal Medicine | |
| 363AM0700X Physician Assistant, Medical (Licence: MI 5601007382) | |
| 363AM0700X Physician Assistant, Medical (Licence: NY 01864-1/8963899) | |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2016-12-22 |