Healthcare Provider Details

I. General information

NPI: 1609701275
Provider Name (Legal Business Name): DIALYSIS ACCESS CARE OF SOUTHEAST MICHIGAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2890 WASHTENAW RD
YPSILANTI MI
48197-1507
US

IV. Provider business mailing address

5333 MCAULEY DR RM 4003
YPSILANTI MI
48197-1099
US

V. Phone/Fax

Practice location:
  • Phone: 734-528-9433
  • Fax: 734-582-9455
Mailing address:
  • Phone: 734-715-1706
  • Fax: 734-863-3602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TABETHA THOMPSON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 734-715-1706