| NPI | 1881862324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MILTON D SODERBERG Physician 906-225-3939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MI MS026190) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: MI MS026190) |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2008-05-06 |