| NPI | 1629066238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE H KOHN Medical Director 231-737-1335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2010-11-24 |