| NPI | 1538192018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK A KUTRIATA Owner/Provider 269-429-7546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 5101012454) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2010-03-25 |