| NPI | 1649272386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYDIA L MUTCH Credentialing Coordinator 267-479-4142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2020-09-02 |