Organization
SOUTHEASTERN MICHIGAN KIDNEY CENTER PLLC
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
1695 W 12 MILE RD, SUITE 250, BERKLEY, MI 48072-2183
(248) 414-5200
(248) 414-5227
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
—
000000009371
CAPE
—
01
—
08981
BLUE CROSS PRIMARY
—
01
—
09499
BLUE CROSS SECONDARY
—
01
—
1022510001
WELLNESS
—
01
—
140042
CARE CHOICES
—
01
—
232574
HAP
—
05
—
4112097
—
MI
01
—
501076
ULTI MED
—
01
—
567595
SELECTCARE
—
01
—
8203
GREATLAKES
—
01
—
OP630345
M CARE
—
01
—
P117519
BLUE CARE NETWORK
—
Enumeration date
07/20/2006
Last updated
09/28/2011
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