| NPI | 1740692474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA M. JAKSIC Executive Director 906-228-3613 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2014-06-10 |