| NPI | 1780078477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN THEISEN Acct 786-475-3971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2024-08-23 |