| NPI | 1962429878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA MUSIC Director Of Provider Enrollment 877-892-9815 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 4270) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207RG0100X Internal Medicine, Gastroenterology | |
| 207V00000X Obstetrics & Gynecology | |
| 207Y00000X Otolaryngology | |
| 208800000X Urology | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2025-06-25 |