Organization
PEDIATRIC CARDIOLOGY OF SOUTHEASTREN MICHIGAN
Active
Organization
PEDIATRIC CARDIOLOGY OF SOUTHEASTREN MICHIGAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REGINA C SHADE (CONSULTANT)
(586) 260-2858
Entity
Organization
Contact information
Practice address
1934 BLUFF CT, TROY, MI 48098-6616
(248) 312-0005
(248) 940-2949
Mailing address
1934 BLUFF CT, TROY, MI 48098-6616
(248) 312-0005
(248) 940-2949
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316244304
—
MI
05
—
1770551301
—
MI
Enumeration date
05/21/2019
Last updated
05/21/2019
Update your record
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