| NPI | 1730465881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA K MILLER Dr./Provider/Owner 641-682-5451 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA 23196) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA 28019) |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2011-11-02 |