| NPI | 1558761866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAMITKO MOORE Owner 313-539-4840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301043030) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801092021) |
| 1041C0700X Social Worker Clinical | |
| 363AM0700X Physician Assistant Medical (Licence: MI 5601002272) | |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2014-09-16 |