| NPI | 1871108217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INGRID N. LEWIS Authorized Official/Fnp 313-930-0258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2020-09-12 |
| Last Update Date | 2020-09-12 |