| NPI | 1740056589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA MIRCHEV Credentialing Specialist 734-673-2946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery |
| Enumeration Date | 2023-12-04 |
| Last Update Date | 2023-12-04 |