SOUTHEASTERN MICHIGAN KIDNEY CENTER PLLC NPI 1316967797

NPI Information

NPI: 1316967797
Provider Name: SOUTHEASTERN MICHIGAN KIDNEY CENTER PLLC
Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 23D0951130

Address:
1695 W 12 MILE RD
SUITE 250
BERKLEY, MI
ZIP 48072
Phone: (248) 414-5200
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SOUTHEASTERN MICHIGAN KIDNEY CENTER PLLC is an end-stage renal disease (esrd) treatment clinic center in Berkley, MI. SOUTHEASTERN MICHIGAN KIDNEY CENTER PLLC NPI is 1316967797. The provider is registered as an organization entity type.

The provider's business location address is:

1695 W 12 MILE RD
SUITE 250
BERKLEY, MI
ZIP 48072-183
Phone: (248) 414-5200
Fax: (248) 414-5227

The provider's authorized official is David F Shepherd .
The authorized official title is Vice President and has the following contact phone number (248) 642-5038.

The CLIA number assigned to this NPI record is 23D0951130 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/20/2006 and was last updated on 9/28/2011.

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
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	232574	OTHER		HAP
2	08981	OTHER		BLUE CROSS PRIMARY
3	4112097	MEDICAID	MICHIGAN
4	1022510001	OTHER		WELLNESS
5	P117519	OTHER		BLUE CARE NETWORK
6	000000009371	OTHER		CAPE
7	232574	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA
8	140042	OTHER		PREFERRED CHOICE
9	8203	OTHER		GREATLAKES
10	08981	OTHER		FED BLUE CROSS PRIMARY
11	567595	OTHER		SELECTCARE
12	OP630345	OTHER		M CARE
13	09499	OTHER		BLUE CROSS SECONDARY
14	501076	OTHER		ULTI MED
15	09499	OTHER		FED BLUE CROSS SECONDARY
16	140042	OTHER		CARE CHOICES

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: 5/5/2024

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