Healthcare Provider Details

I. General information

NPI: 1821000670
Provider Name (Legal Business Name): PETER J CLIVE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 MAIN ST
MARLETTE MI
48453-1141
US

IV. Provider business mailing address

2815 BARDAMAR DR
FORT GRATIOT MI
48059-3505
US

V. Phone/Fax

Practice location:
  • Phone: 989-635-1833
  • Fax: 810-385-0933
Mailing address:
  • Phone: 810-385-9621
  • Fax: 810-385-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number067301
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: