Organization
NORTHWEST DETROIT DIALYSIS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID F SHEPHERD (VICE PRESIDENT)
(248) 642-5038
Entity
Organization
Contact information
Practice address
25664 LAHSER RD, SOUTHFIELD, MI 48033-5810
(248) 358-7521
(248) 358-7522
Mailing address
30100 TELEGRAPH RD, SUITE 200, BINGHAM FARMS, MI 48025-4516
(248) 723-0224
(248) 642-7852
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000003402
CAPE
—
01
—
10078540001
WELLNESS
—
01
—
1008733
OMNICARE
—
01
—
138129
PREFERRED CHOICE
—
01
—
14296
M CARE
—
01
—
232544
HAP
—
05
—
4568218
—
MI
01
—
5066
GREATLAKES
—
01
—
D8956
FED BLUE CROSS PRIMARY
—
01
—
D9466
BLUE CROSS SECONDARY
—
01
—
P09457
BLUE CARE NETWORK
—
Enumeration date
07/20/2006
Last updated
10/15/2012
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