| Clarkston Primary Care | |
|
50 N Perry St Pontiac MI 48342-2217 | |
| (248) 338-5000 | |
| (248) 338-5584 |
| Full Name | Clarkston Primary Care |
|---|---|
| Speciality | Internal Medicine |
| Location | 50 N Perry St, Pontiac, Michigan |
| Authorized Official Name and Position | Clarence Sevillian (CEO/PRESIDENT) |
| Authorized Official Contact | 2483385380 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clarkston Primary Care 50 N Perry St Pontiac MI 48342-2217 Ph: (248) 338-5000 | Clarkston Primary Care 50 N Perry St Pontiac MI 48342-2217 Ph: (248) 338-5000 |
| NPI Number | 1609970359 |
|---|---|
| Provider Enumeration Date | 09/12/2006 |
| Last Update Date | 04/08/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609970359 | NPI | - | NPPES |
| 0F31232 | Other | MI | BLUE SHIELD GROUP PIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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