Organization
SOUTH LYON DERMATOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA M CLAY DO (AUTHORIZED REP/OWNER)
(248) 479-2200
Entity
Organization
Contact information
Practice address
26036 PONTIAC TRL, SOUTH LYON, MI 48178-8050
(248) 479-2200
(248) 479-2682
Mailing address
26036 PONTIAC TRL, SOUTH LYON, MI 48178-8050
(248) 479-2200
(248) 479-2682
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407233323
—
MI
Enumeration date
04/29/2015
Last updated
07/16/2015
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