Healthcare Provider Details

I. General information

NPI: 1154439651
Provider Name (Legal Business Name): DONALD CLEMENTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2183 NEWBURGH DR
TROY MI
48083-2524
US

IV. Provider business mailing address

2183 NEWBURGH DR
TROY MI
48083-2524
US

V. Phone/Fax

Practice location:
  • Phone: 248-528-2599
  • Fax: 248-528-2599
Mailing address:
  • Phone: 248-528-2599
  • Fax: 248-528-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901001978
License Number StateMI

VIII. Authorized Official

Name: MR. DONALD MICHAEL CLEMENTE JR.
Title or Position: SOLE MEMBER
Credential: DPM
Phone: 734-788-2107