| NPI | 1598145997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISTY GUNTER RUSSIAN Supervisor Provider Enrollment 517-253-6308 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine Sports Medicine (Licence: MI 1060000091) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2025-04-01 |