| NPI | 1699164699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAWAZ HASSO Medical Director 248-259-1183 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MI 4301083265) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: MI 4301088431) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2015-04-21 |