| NPI | 1629272968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY CEBALT Director 313-874-6767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207RX0202X Internal Medicine, Medical Oncology |
| 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology | |
| 204E00000X Oral & Maxillofacial Surgery | |
| 207V00000X Obstetrics & Gynecology | |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism | |
| 1223G0001X Dentist, General Practice | |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2026-04-28 |