| NPI | 1992584783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA KRUEGER VP Of Revenue Cycle 888-408-7008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207QA0505X Family Medicine, Adult Medicine | |
| 208100000X Physical Medicine & Rehabilitation | |
| Enumeration Date | 2023-09-21 |
| Last Update Date | 2025-11-17 |