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General NPI Number Information
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NPI Number | 1932396496
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Entity Type | Organization
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Legal Business Name | KIDNEY CONSULTANTS OF MICHIGAN PC
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Dates
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Enumeration Date | 09/28/2007
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 25710 KELLY RD STE 1
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City | ROSEVILLE
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State | MI
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Zip | 48066
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Country | US
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Telephone | 586-772-2600
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Fax | 586-772-5289
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Provider Business Mailing Address
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Address Line | 25710 KELLY RD STE 1
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City | ROSEVILLE
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State | MI
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Zip | 48066-4959
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Country | US
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Telephone | 586-772-2600
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Fax | 586-772-5289
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Authorized Official
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Title or Position | OWNER
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Name | DR. ABDUL R EFFENDI
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Credential | MD
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Telephone | 586-772-2600
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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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