| NPI | 1952485351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON PHILLIPS Provider Enrollment Specialist 313-874-2892 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 830190) |
| 2083A0100X Preventive Medicine, Aerospace Medicine | |
| 2083X0100X Preventive Medicine, Occupational Medicine | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2024-09-03 |