| NPI | 1578369997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY JO UECKER Credentialing Specialist 269-420-9404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Enumeration Date | 2025-02-25 |
| Last Update Date | 2025-02-25 |