| NPI | 1891740130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH JAMES Provider Enrollment Coordinator 989-701-4734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2022-09-27 |