| NPI | 1568829224 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA MUSIC Director, Provider Enrollment 877-892-9815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207RC0000X Internal Medicine Cardiovascular Disease | |
| 207RI0011X Internal Medicine Interventional Cardiology | |
| 207W00000X Ophthalmology | |
| 208600000X Surgery | |
| 208000000X Pediatrics | |
| 2083X0100X Preventive Medicine Occupational Medicine | |
| 367A00000X Advanced Practice Midwife | |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2025-06-25 |