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
21000 NORTHWESTERN HWY, SOUTHFIELD, MI 48075-5306
(248) 557-7000
(248) 557-7786
Mailing address
30100 TELEGRAPH RD, STE 200, BINGHAM FARMS, MI 48025-4516
(248) 642-5038
(248) 642-7140
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
B8672P
MI
Other
Enumeration date
07/13/2010
Last updated
10/25/2012
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