| NPI | 1770869257 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL KELLEY Manager, Credentialing And Enrollme 313-993-6080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601006086) |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2011-10-27 |