Provider Demographics
NPI:1154439651
Name:DONALD CLEMENTE PLLC
Entity Type:Organization
Organization Name:DONALD CLEMENTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CLEMENTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-788-2107
Mailing Address - Street 1:2183 NEWBURGH DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2524
Mailing Address - Country:US
Mailing Address - Phone:248-528-2599
Mailing Address - Fax:248-528-2599
Practice Address - Street 1:2183 NEWBURGH DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2524
Practice Address - Country:US
Practice Address - Phone:248-528-2599
Practice Address - Fax:248-528-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001978213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4856352060OtherBCBS OF MICHIGAN
MI4467304Medicaid
MI4467304Medicaid
MION63700Medicare ID - Type Unspecified