Organization
MACOMB NEPHROLOGY ASSOCIATES P.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY GUNST (OFFICE MANAGER)
(586) 228-1010
Entity
Organization
Contact information
Practice address
15520 19 MILE RD, SUITE 480, CLINTON TWP, MI 48038-6333
(586) 228-1010
(586) 228-8570
Mailing address
15520 19 MILE RD, SUITE 480, CLINTON TWP, MI 48038-6333
(586) 228-1010
(586) 228-8570
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110E01220
BLUE CROSS BLUE SHIELD MI
MI
Enumeration date
10/09/2006
Last updated
04/18/2022
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