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General NPI Number Information
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NPI Number | 1922275312
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Entity Type | Organization
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Legal Business Name | ST. CLAIR CARDIOVASCULAR SURGEONS, PLC
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 1117 STONE ST SUITE 1
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City | PORT HURON
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State | MI
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Zip | 48060-3525
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Country | US
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Telephone | 810-987-3558
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Fax | 810-987-7557
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Provider Business Mailing Address
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Address Line | 25599 KELLY RD SUITE A.
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City | ROSEVILLE
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State | MI
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Zip | 48066-4975
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Country | US
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Telephone | 586-772-6000
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Fax | 586-772-7700
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Authorized Official
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Title or Position | TRUSTEE
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Name | C. DOUGLAS LEES
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Credential | M.D.
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Telephone | 586-772-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 4301047134
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License Number State | MI
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