| NPI | 1881763753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH C HANSON Owner 989-723-7619 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: MI 4301027519) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-08-22 |