Healthcare Provider Details

I. General information

NPI: 1699879221
Provider Name (Legal Business Name): CLARE SEKERAK N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 FULLER RD 112 N
ANN ARBOR MI
48105-2335
US

IV. Provider business mailing address

15090 ENGLEWOOD AVE
ALLEN PARK MI
48101-1628
US

V. Phone/Fax

Practice location:
  • Phone: 734-769-7100
  • Fax: 734-769-7056
Mailing address:
  • Phone: 313-383-6174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704171706
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: