Healthcare Provider Details

I. General information

NPI: 1295765071
Provider Name (Legal Business Name): RENAL CENTER PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 ELECTRIC AVE STE E
PORT HURON MI
48060-6587
US

IV. Provider business mailing address

22201 MOROSS RD STE 150
DETROIT MI
48236-2152
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-5252
  • Fax: 810-987-2120
Mailing address:
  • Phone: 586-247-4300
  • Fax: 586-532-6496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUBBANA GOUNDER MUTHUSWAMI
Title or Position: PRESIDENT
Credential: MD
Phone: 810-987-5252