| NPI | 1972894566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE C JACKS PORTER VP/CFO 989-894-3838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005840) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301062477) |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704214196) | |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2019-05-22 |