| NPI | 1669799128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA BROWN Billing Manager 586-251-2095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MI ZP064027) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI DM050196) |
| 207R00000X Internal Medicine (Licence: MI 4301064027) | |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2024-05-16 |