| NPI | 1629198544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SATISH RAVI Authorized Official 386-328-6746 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2024-09-12 |