| NPI | 1730751660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERI M JOHNSON Billing Supervisor 810-233-7103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2022-11-02 |