Organization
MACOMB REGIONAL DIALYSIS CENTERS, L.L.C.
Active
Other names
Macomb Regional Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FREDERICK SHEPHERD (VICE PRESIDENT / MANAGING AGENT)
(248) 642-5038
Entity
Organization
Contact information
Practice address
16151 NINTEEN MILE RD, SUITE 200, CLINTON TOWNSHIP, MI 48038-1158
(586) 263-8350
(586) 263-8358
Mailing address
30100 TELEGRAPH ROAD, SUITE 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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D8792
BLUE CROSS TRADITIONAL AND TRUST
MI
01
—
S09456
BLUE CROSS TRADITIONAL AND TRUST SUPPLEMENTAL
MI
Enumeration date
06/26/2007
Last updated
10/15/2018
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