| NPI | 1740512201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN AGBEBIYI Owner 248-946-2050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301041053) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: MI 4301041053) |
| 207V00000X Obstetrics & Gynecology (Licence: MI 4301041053) | |
| Enumeration Date | 2010-02-09 |
| Last Update Date | 2011-04-29 |