| NPI | 1629117411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER L FRUSTAGLIO Office Manager 906-225-4782 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: MI 5901001221) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: MI 5901001221) |
| 213ES0131X Podiatrist Foot Surgery (Licence: MI 5901001221) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-08-22 |