| NPI | 1629027826 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA MUSIC Director, Provider Enrollment 877-892-9815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207X00000X Orthopaedic Surgery | |
| 208000000X Pediatrics | |
| 208VP0000X | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2025-06-16 |