| NPI | 1689035842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA THOMPSON VP, Provider Relations &Contracting 586-913-6148 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Additional Taxonomies | 231H00000X Audiologist |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2023-02-13 |