Healthcare Provider Details

I. General information

NPI: 1003814955
Provider Name (Legal Business Name): ALASDAIR I.L. MCKENDRICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22250 PROVIDENCE DR SUITE 208
SOUTHFIELD MI
48075-4825
US

IV. Provider business mailing address

22250 PROVIDENCE DR SUITE 208
SOUTHFIELD MI
48075-4825
US

V. Phone/Fax

Practice location:
  • Phone: 248-557-8780
  • Fax: 248-557-3242
Mailing address:
  • Phone: 248-557-8780
  • Fax: 248-557-3242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberAM033769
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: