| NPI | 1982824512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES PATRICK WIADUCK Medical Director 231-798-8337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MI 4301066579) |
| Additional Taxonomies | 2084P0015X Psychiatry & Neurology Psychosomatic Medicine (Licence: MI 4301066579) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2020-01-08 |