ST CLAIR SPECIALTY PHYSICIANS PC NPI 1154361616

NPI Information

  • NPI: 1154361616
  • Provider Name: ST CLAIR SPECIALTY PHYSICIANS PC
  • Classification: Internal Medicine - 207RN0300X
  • Specialization: Nephrology
  • Entity Type: Organization
  • Doing Business As: ST. CLAIR NEPHROLOGY, IDAHO NEPHROLOGY ASSOCIATES
  • CLIA Number: 23D2100716
  • Address: 18001 E 10 MILE RD
    SUITE 1
    ROSEVILLE, MI
    ZIP 48066
  • Phone: (586) 218-5800

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NPI Details

ST CLAIR SPECIALTY PHYSICIANS PC is a nephrology internal medicine in Roseville, MI. The provider is an internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. ST CLAIR SPECIALTY PHYSICIANS PC NPI is 1154361616. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As St. Clair Nephrology, Idaho Nephrology Associates.

The provider's business location address is:

18001 E 10 MILE RD
SUITE 1
ROSEVILLE, MI
ZIP 48066-803
Phone: (586) 218-5800
Fax: (586) 532-6496

The provider's authorized official is Christopher Robert Provenzano .
The authorized official title is Ceo/managing Employee (w2) and has the following contact phone number (586) 286-7800.

The CLIA number assigned to this NPI record is 23D2100716 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/6/2006 and was last updated on 10/17/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12086S0129XSurgeryVascular SurgeryNo
2207RN0300XInternal MedicineNephrologyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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