| Stony Creek Internal Medicine Plc | |
|
52915 Mound Road Shelby Township MI 48316-3266 | |
| (586) 992-2400 | |
| Not Available |
| Full Name | Stony Creek Internal Medicine Plc |
|---|---|
| Speciality | Internal Medicine |
| Location | 52915 Mound Road, Shelby Township, Michigan |
| Authorized Official Name and Position | Lisa Hall (OWNER) |
| Authorized Official Contact | 5869922400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stony Creek Internal Medicine Plc 52915 Mound Road Shelby Township MI 48316-3266 Ph: (586) 992-2400 | Stony Creek Internal Medicine Plc 52915 Mound Road Shelby Township MI 48316-3266 Ph: (586) 992-2400 |
| NPI Number | 1093835647 |
|---|---|
| Provider Enumeration Date | 03/29/2007 |
| Last Update Date | 12/19/2012 |
| Medicare PECOS PAC ID | 9830185362 |
|---|---|
| Medicare Enrollment ID | O20040421001117 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093835647 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Lisa Marie Hall |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992864417 PECOS PAC ID: 8820984438 Enrollment ID: I20040223000200 |
| Provider Name | Alicia Ann Gaspar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740729961 PECOS PAC ID: 9739419573 Enrollment ID: I20190923000433 |
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