Organization
ST CLAIR SPECIALTY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT PROVENZANO MD (PRESIDENT/PARTNER)
(313) 886-8787
Entity
Organization
Contact information
Practice address
5610 GAGE STREET, SUITE A, BOISE, ID 83706
(208) 367-3370
Mailing address
45640 SCHOENHERR ROAD, SHELBY TWP, MI 48315
(586) 247-4300
(586) 532-6496
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Enumeration date
02/24/2011
Last updated
02/24/2011
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