| NPI | 1780059790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREG C MANN Owner 260-750-3965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 208D00000X General Practice |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 207QG0300X Family Medicine, Geriatric Medicine | |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2025-11-10 |