| NPI | 1780638080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELANIE L MICK Medical Credentialing Consultant 234-855-6458 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2013-06-05 |