Organization
CLARKSTON URGENT CARE PLC
Active
Parent organization
CLARKSTON MEDICAL GROUP, PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CLARKSTON MEDICAL GROUP, PC
Authorized official
TIMOTHY R ONEILL DO (PRESIDENT)
(248) 625-2621
Entity
Organization
Contact information
Practice address
5701 BOW POINTE DR, SUITE 120, CLARKSTON, MI 48346-3198
(248) 625-2273
(248) 625-6336
Mailing address
5701 BOW POINTE DR, SUITE 120, CLARKSTON, MI 48346-3198
(248) 625-2273
(248) 625-6336
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
5101011134
MI
207Q00000X
Family Medicine Physician
5101009832
MI
207R00000X
Internal Medicine Physician
Primary
4301074879
MI
208000000X
Pediatrics Physician
4301048260
MI
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
5101011123
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760708499
—
MI
01
—
616157800
DEPT OF LABOR
MI
01
—
700F392560
BCBS GROUP
MI
01
—
DR1705
RAILROAD MEDICARE GROUP
MI
Enumeration date
04/20/2010
Last updated
08/22/2011
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