Organization
PINETREE MEDICAL CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAMIM A ISLAM MD (CEO)
(248) 935-1931
Entity
Organization
Contact information
Practice address
4186 PONTIAC LAKE RD, WATERFORD, MI 48328-1258
(248) 935-1931
Mailing address
4186 PONTIAC LAKE RD, WATERFORD, MI 48328-1258
(248) 935-1931
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F32626
BCBSM
MI
Enumeration date
06/09/2008
Last updated
08/29/2008
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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