| Organization Name: | LOVE KNOT MEDICAL CENTER,LLC |
| NPI Number: | 1275802647 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KANISHA BREWER (ADMINSTRATOR) |
| Mailing Address: | 17234 Goddard Rd Allen Park |
| State: | MI US |
| Postal Code: | 481014100 |
| Phone Number: | 3136271422 |
| Fax Number: | |
| NPI Enumeration Date: | 12/14/2011 |
| NPI Last Update Date: | 12/14/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP3300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Pain |
| Taxonomy Definition: | |