| NPI | 1649742834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY WILSON Medical Biller/Manager 248-239-5300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2018-12-28 |
| Last Update Date | 2019-10-28 |