Shenandoah Clinic, P.c. | |
909 W Maple Rd Suite 100 Clawson MI 48017-1000 | |
(248) 435-2028 | |
(248) 435-2099 |
Full Name | Shenandoah Clinic, P.c. |
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Speciality | Family Medicine |
Location | 909 W Maple Rd, Clawson, Michigan |
Authorized Official Name and Position | Ronald I Rothenberg (PHYSICIAN/PRESIDENT) |
Authorized Official Contact | 2484352028 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Shenandoah Clinic, P.c. 909 W Maple Rd Suite 100 Clawson MI 48017-1000 Ph: (248) 435-2028 | Shenandoah Clinic, P.c. 909 W Maple Rd Suite 100 Clawson MI 48017-1000 Ph: (248) 435-2028 |
NPI Number | 1043394877 |
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Provider Enumeration Date | 10/25/2006 |
Last Update Date | 02/24/2022 |
Medicare PECOS PAC ID | 6608058284 |
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Medicare Enrollment ID | O20110303000795 |
Identifier | Type | State | Issuer |
---|---|---|---|
1043394877 | NPI | - | NPPES |
080F319020 | Other | MI | BLUE CROSS BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Ronald Rothenberg |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1487634986 PECOS PAC ID: 7416071949 Enrollment ID: I20100903000765 |
Provider Name | Nidhi M Shishu |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1942280177 PECOS PAC ID: 4082896568 Enrollment ID: I20110303000875 |
Provider Name | Joseph Martin Masternick |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1548240237 PECOS PAC ID: 3678578093 Enrollment ID: I20110304000075 |
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