| St Clair Adult Medicine Specialists Pc | |
|
23411 Jefferson Ave Suite 100 Saint Clair Shores MI 48080-1949 | |
| (586) 778-4080 | |
| (586) 778-6055 |
| Full Name | St Clair Adult Medicine Specialists Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 23411 Jefferson Ave, Saint Clair Shores, Michigan |
| Authorized Official Name and Position | Mary Beth Hardwicke (OWNER/PHYSICIAN) |
| Authorized Official Contact | 5867784080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St Clair Adult Medicine Specialists Pc Po Box 673215 Detroit MI 48267-3215 Ph: (586) 778-4080 | St Clair Adult Medicine Specialists Pc 23411 Jefferson Ave Suite 100 Saint Clair Shores MI 48080-1949 Ph: (586) 778-4080 |
| NPI Number | 1508864620 |
|---|---|
| Provider Enumeration Date | 07/12/2005 |
| Last Update Date | 07/16/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508864620 | NPI | - | NPPES |
| 4240936 | Medicaid | MI | |
| 3389123 | Medicaid | MI | |
| 110E010920 | Other | MI | BCBS BCN |
| 3384323 | Medicaid | MI | |
| 4613977 | Medicaid | MI | |
| 4989630 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MH404922 (Michigan) | Primary |
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