| NPI | 1619748191 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY LEE MCAULEY Credentialing Specialist 586-771-4820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2024-01-12 |
| Last Update Date | 2025-01-14 |