| NPI | 1881874923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEGGY HAGEN Provider Enrollment Specialist 248-857-7583 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301081689) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2007-11-06 |