Medical school: WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Graduated: 1970
Offers telehealth
NPI: 1962637413
Practice Locations (2)
8551 FAR RAVINE DR
PINCKNEY, MI 481698600
8105889204
8551 FAR RAVINE DR, BEVERLY COSTINEW
PINCKNEY, MI 481698600
Source: CMS National Downloadable File, September 2026.