| NPI | 1942388368 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA MUSIC Director Of Provider Enrollment 877-892-9815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| 208000000X Pediatrics | |
| 208100000X Physical Medicine & Rehabilitation | |
| 207P00000X Emergency Medicine | |
| 207R00000X Internal Medicine | |
| 207RH0003X Internal Medicine, Hematology & Oncology | |
| 2083X0100X Preventive Medicine, Occupational Medicine | |
| 208600000X Surgery | |
| 208C00000X Colon & Rectal Surgery | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2023-11-06 |