| NPI | 1942510623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN R RUARK Member 734-414-9990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 213E00000X Podiatrist | |
| 335V00000X Portable X-Ray and/or Other Portable Diagnostic Imaging Supplier | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2011-04-22 |