Healthcare Provider Details
I. General information
NPI: 1295780997
Provider Name (Legal Business Name): EMERGENCY CARE SPECIALISTS OF ST. CLAIR COUNTY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/23/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2601 ELECTRIC AVE
PORT HURON MI
48060-6587
US
IV. Provider business mailing address
17717 MASONIC
FRASER MI
48026-3158
US
V. Phone/Fax
- Phone: 810-985-1500
- Fax:
- Phone: 586-294-0600
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207P00000X |
| Taxonomy | Emergency Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
JERE
F
BALDWIN
Title or Position: OWNER
Credential: M.D.
Phone: 248-642-9878