| NPI | 1730669151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLA PROVOST Billing Service 989-249-1922 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI JP084288) |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2023-04-06 |