Healthcare Provider Details

I. General information

NPI: 1831130723
Provider Name (Legal Business Name): MICHIGAN KIDNEY CONSULTANTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5280 METROPOLITAN PKWY
STERLING HEIGHTS MI
48310-4005
US

IV. Provider business mailing address

PO BOX 77000 DEPARTMENT 771267
DETROIT MI
48277-1267
US

V. Phone/Fax

Practice location:
  • Phone: 248-290-3111
  • Fax: 248-290-3100
Mailing address:
  • Phone: 248-290-3111
  • Fax: 248-290-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID MCKAY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 248-290-3111