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
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