Healthcare Provider Details

I. General information

NPI: 1346776044
Provider Name (Legal Business Name): TIFFANY MARIE ST. CLAIR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6667 ORCHARD LAKE RD
WEST BLOOMFIELD MI
48322-3404
US

IV. Provider business mailing address

6667 ORCHARD LAKE RD
WEST BLOOMFIELD MI
48322-3404
US

V. Phone/Fax

Practice location:
  • Phone: 248-206-8950
  • Fax: 248-206-8951
Mailing address:
  • Phone: 248-206-8950
  • Fax: 248-206-8951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301512692
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: