| NPI | 1639890320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDSAY BARKER Enrollment Specialist 734-373-0849 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2022-09-09 |
| Last Update Date | 2022-10-10 |