| NPI | 1821027756 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE PHILLIPS Podiatrist 313-345-4449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MI 5901001422) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MI 5901001422) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2011-12-09 |