| NPI | 1720369671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE C JACKS PORTER CFO 989-894-3838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363A00000X Physician Assistant | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2018-08-07 |