Organization
PANACEA PORTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN ROUSE (PRESIDENT)
(248) 509-4774
Entity
Organization
Contact information
Practice address
6457 HICKORY LN, BURTON, MI 48509-9303
(248) 509-4774
Mailing address
6457 HICKORY LN, BURTON, MI 48509-9303
(248) 509-4774
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
04/20/2022
Last updated
04/20/2022
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