| NPI | 1811190101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINE TAYLOR Credentialing Coordinator 810-230-7042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301069853) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2018-02-09 |