| NPI | 1962057190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYDIA ROSE STEVENS Billing/Revenue Cycle Coordinator 989-779-5642 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2020-01-08 |