| NPI | 1942317631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY CEBALT Director Of Provider Affairs 313-874-6764 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine |
| 207VG0400X Obstetrics & Gynecology, Gynecology | |
| 2085R0202X Radiology, Diagnostic Radiology | |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| 2080A0000X Pediatrics, Adolescent Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 208000000X Pediatrics | |
| 207VX0000X Obstetrics & Gynecology, Obstetrics | |
| 207R00000X Internal Medicine | |
| 207RG0300X Internal Medicine, Geriatric Medicine | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2026-04-28 |