| NPI | 1871100438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAUSKA BASHABE Nurse Practitioner 313-712-6763 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2020-09-28 |
| Last Update Date | 2020-09-28 |