| NPI | 1972806594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE ANDRES Credentialing/Billing 616-754-6949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301053623) |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2010-12-21 |