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General NPI Number Information
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NPI Number | 1295765071
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Entity Type | Organization
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Legal Business Name | RENAL CENTER PHYSICIANS
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 2607 ELECTRIC AVE STE E
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City | PORT HURON
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State | MI
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Zip | 48060-6587
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Country | US
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Telephone | 810-987-5252
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Fax | 810-987-2120
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Provider Business Mailing Address
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Address Line | 22201 MOROSS RD STE 150
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City | DETROIT
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State | MI
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Zip | 48236-2152
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Country | US
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Telephone | 586-247-4300
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Fax | 586-532-6496
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUBBANA GOUNDER MUTHUSWAMI
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Credential | MD
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Telephone | 810-987-5252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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