| NPI | 1750564050 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT T GRODMAN Owner 313-295-1620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 001478) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MI 001478) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2017-03-03 |