Organization
RENAL TREATMENT CENTERS-ILLINOIS INC
Active
Other names
Novi Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
27150 PROVIDENCE PKWY, STE A, NOVI, MI 48374-1272
(248) 449-6947
(248) 449-6995
Mailing address
ATT: 5200 VIRGINIA WAY, ATT: L&C DEPARTMENT, BRENTWOOD, TN 37027-7569
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
05
—
1073574596
—
MI
Enumeration date
05/08/2015
Last updated
05/08/2024
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