| NPI | 1518745017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA G HICKS Credentialing Manager 586-489-9436 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology |
| Enumeration Date | 2023-09-18 |
| Last Update Date | 2024-02-24 |