| NPI | 1902202716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF MICHEAL MASTIN Administrative Assistant 586-751-0200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MI 5101006690) |
| Additional Taxonomies | 261QP1100X Clinic/Center, Podiatric (Licence: MI 5901000447) |
| 261QP1100X Clinic/Center, Podiatric (Licence: MI 5901001570) | |
| 261QP1100X Clinic/Center, Podiatric (Licence: MI 5901000468) | |
| 261QP2300X Clinic/Center, Primary Care (Licence: MI 4301025138) | |
| 261QP2300X Clinic/Center, Primary Care (Licence: MI 4301046450) | |
| 261QP2300X Clinic/Center, Primary Care (Licence: MI 4301095717) | |
| Enumeration Date | 2014-11-06 |
| Last Update Date | 2014-11-06 |