Healthcare Provider Details

I. General information

NPI: 1750373676
Provider Name (Legal Business Name): ASSOCIATED INTERNISTS OF MACOMB PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50505 SCHOENHERR RD SUITE 300
SHELBY TOWNSHIP MI
48315-3141
US

IV. Provider business mailing address

50505 SCHOENHERR RD SUITE 300
SHELBY TOWNSHIP MI
48315-3140
US

V. Phone/Fax

Practice location:
  • Phone: 586-726-5566
  • Fax: 586-726-8085
Mailing address:
  • Phone: 586-726-5566
  • Fax: 586-726-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD J PIERSKALLA
Title or Position: OWNER/PARTNER
Credential: M.D.
Phone: 586-726-5566