Healthcare Provider Details

I. General information

NPI: 1699859835
Provider Name (Legal Business Name): CLAWSON INTERNIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 S MAIN ST
CLAWSON MI
48017-2061
US

IV. Provider business mailing address

PO BOX 1829
TROY MI
48099
US

V. Phone/Fax

Practice location:
  • Phone: 248-588-4777
  • Fax: 248-588-1241
Mailing address:
  • Phone: 248-588-4777
  • Fax: 248-588-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301057675
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301067271
License Number StateMI

VIII. Authorized Official

Name: NIRAJ SHAH
Title or Position: OWNER
Credential: MD
Phone: 248-588-4777