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Organization

SOUTHEASTERN MICHIGAN MEDICAL CONSULTANTS PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RUDY JEROME VERVAEKE MD (CEO)
(586) 775-7400
Entity
Organization

Contact information

Practice address
21420 HARPER AVE, SUITE 2, SAINT CLAIR SHORES, MI 48080-3607
(586) 775-7400
(586) 775-0091
Mailing address
21420 HARPER AVE, SUITE 2, SAINT CLAIR SHORES, MI 48080-3607
(586) 775-7400
(586) 775-0091

Taxonomy

Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
4301044898
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
010E023690
BCBS
MI
05
1942300884
MI
01
4329604
AETNA
MI
01
B47051
HAP
MI
01
DE9629
RAILROAD MEDICARE GROUP
MI
Enumeration date
09/22/2006
Last updated
02/06/2015
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