| NPI | 1932202579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN P VAN DONGEN Owner/President 239-643-7888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME73716) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME127276) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2018-01-10 |