| NPI | 1740645381 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NAZEM ABDELFATTAH Medical Doctor 269-381-2800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301062116) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704241734) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MI ME120998) | |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2016-05-25 |