| NPI | 1659113462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY JOHN CARROLL Owner 586-436-3785 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2024-06-11 |
| Last Update Date | 2024-06-11 |