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SHELBYDALE MEDICAL CLINIC P.C. NPI 1629258488


NPI Information

NPI: 1629258488
Provider Name: SHELBYDALE MEDICAL CLINIC, P.C.
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 23D0868870

Address:
49221 VAN DYKE AVE
SHELBY TWP, MI
ZIP 48317
Phone: (586) 254-4860
Get Directions

SHELBYDALE MEDICAL CLINIC, P.C. is a family medicine in Shelby Twp, MI. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. SHELBYDALE MEDICAL CLINIC, P.C. NPI is 1629258488. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

49221 VAN DYKE AVE
SHELBY TWP, MI
ZIP 48317-336
Phone: (586) 254-4860
Fax: (586) 254-5844

The provider's authorized official is Keith B Tom .
The authorized official title is President and has the following contact phone number (586) 254-4860.

The CLIA number assigned to this NPI record is 23D0868870 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 11/9/2007 and was last updated on 11/9/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineKT008999MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12646558MEDICAIDMICHIGAN
20P04980MEDICARE PIN
3A77750MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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