| NPI | 1770863839 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLLEEN JOHNSON Office Manger 231-728-5910 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2014-03-03 |