| NPI | 1649547654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE L POPOUR Office Manager 906-632-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI TT007907) |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2017-09-14 |