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 |