Shelbydale Medical Clinic, P.c. | |
49221 Van Dyke Ave Shelby Twp MI 48317-1336 | |
(586) 254-4860 | |
(586) 254-5844 |
Full Name | Shelbydale Medical Clinic, P.c. |
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Speciality | Family Medicine |
Location | 49221 Van Dyke Ave, Shelby Twp, Michigan |
Authorized Official Name and Position | Keith B Tom (PRESIDENT) |
Authorized Official Contact | 5862544860 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Shelbydale Medical Clinic, P.c. 49221 Van Dyke Ave Shelby Twp MI 48317-1336 Ph: (586) 254-4860 | Shelbydale Medical Clinic, P.c. 49221 Van Dyke Ave Shelby Twp MI 48317-1336 Ph: (586) 254-4860 |
NPI Number | 1629258488 |
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Provider Enumeration Date | 11/09/2007 |
Last Update Date | 11/09/2007 |
Medicare PECOS PAC ID | 4880651405 |
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Medicare Enrollment ID | O20041215000750 |
Identifier | Type | State | Issuer |
---|---|---|---|
1629258488 | NPI | - | NPPES |
2646558 | Medicaid | MI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | KT008999 (Michigan) | Primary |
Provider Name | Keith Brian Tom |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1609850130 PECOS PAC ID: 1052378676 Enrollment ID: I20041215000775 |
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