| NPI | 1962526624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEAH LAINE MATHESON Office Manager 248-528-0709 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MI 5901001005) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-22 |