| NPI | 1952460081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEID COSOVIC Owner 248-244-8700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X (Licence: MI SC057395) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MI SC057395) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2009-01-20 |