| NPI | 1801940093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL L LONG Vice President 989-907-3095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 208600000X Surgery |
| 2086S0127X Surgery, Trauma Surgery | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MI 4301073051) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MI 4301087160) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301072478) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2008-12-23 |