| NPI | 1619285533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRDELL THOMAS Director 313-579-5989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: MI 6801081677) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: MI 6801081677) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2010-09-14 |