Organization
ST CLAIR SPECIALTY PHYSICIANS PC
Active
Other names
St. Clair Nephrology, Idaho Nephrology Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER ROBERT PROVENZANO MD (CEO/MANAGING EMPLOYEE (W2))
(586) 286-7800
Entity
Organization
Contact information
Practice address
18001 E 10 MILE RD, SUITE 1, ROSEVILLE, MI 48066-3803
(586) 218-5800
(586) 532-6496
Mailing address
45640 SCHOENHERR RD, SHELBY TOWNSHIP, MI 48315-6033
(586) 247-4300
(586) 532-6496
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Enumeration date
06/06/2006
Last updated
10/17/2022
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