Organization
MACOMB INFECTIOUS DISEASE SPECIALISTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICENTE REDONDO M.D. (PRESIDENT)
(586) 932-6331
Entity
Organization
Contact information
Practice address
43134 DEQUINDRE RD, STERLING HEIGHTS, MI 48314-1723
(586) 446-8688
(586) 446-9994
Mailing address
46661 FIELDS DR, SHELBY TOWNSHIP, MI 48315-5135
(586) 932-6331
(586) 797-9111
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110E027660
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
Enumeration date
12/14/2008
Last updated
04/15/2019
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