| NPI | 1922029040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA MUSIC Director Provider Enrollment 877-892-9815 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 207R00000X Internal Medicine | |
| 207RG0100X Internal Medicine, Gastroenterology | |
| 207RI0011X Internal Medicine, Interventional Cardiology | |
| 207V00000X Obstetrics & Gynecology | |
| 207X00000X Orthopaedic Surgery | |
| 207Y00000X Otolaryngology | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 208M00000X Hospitalist | |
| 213E00000X Podiatrist | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2025-08-07 |