Healthcare Provider Details

I. General information

NPI: 1184723694
Provider Name (Legal Business Name): CARL F. CLAVENNA, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S ADAMS RD SUITE 200
BIRMINGHAM MI
48009-6861
US

IV. Provider business mailing address

600 S ADAMS RD SUITE 200
BIRMINGHAM MI
48009-6861
US

V. Phone/Fax

Practice location:
  • Phone: 248-646-3733
  • Fax: 248-642-2566
Mailing address:
  • Phone: 248-646-3733
  • Fax: 248-642-2566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. CARL F CLAVENNA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-646-3733