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Organization
ST CLAIR ADULT MEDICINE SPECIALISTS PC
Active
Organization
ST CLAIR ADULT MEDICINE SPECIALISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY BETH HARDWICKE MD (OWNER/PHYSICIAN)
(586) 778-4080
Entity
Organization
Contact information
Practice address
23411 JEFFERSON AVE, SUITE 100, SAINT CLAIR SHORES, MI 48080-1949
(586) 778-4080
(586) 778-6055
Mailing address
PO BOX 673215, DETROIT, MI 48267-3215
(586) 778-4080
(586) 778-6055
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MH404922
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110E010920
BCBS BCN
MI
05
—
3384323
—
MI
05
—
3389123
—
MI
05
—
4240936
—
MI
05
—
4613977
—
MI
05
—
4989630
—
MI
Enumeration date
07/12/2005
Last updated
07/16/2010
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