| NPI | 1568545218 |
|---|---|
| Other Name | FAMILY PRACTICE CLINIC |
| Entity Type | Organization |
| Authorized Contact | LISA M RUCKER Provider Enrollment Manager 517-355-8462 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| 207Q00000X Family Medicine | |
| 207QG0300X Family Medicine, Geriatric Medicine | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2018-02-08 |