Provider Demographics
NPI:1225103740
Name:NEPHROLOGY HYPERTENSION CLINIC PC
Entity Type:Organization
Organization Name:NEPHROLOGY HYPERTENSION CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHEER
Authorized Official - Middle Name:
Authorized Official - Last Name:UMMADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-271-3000
Mailing Address - Street 1:PO BOX 77000 DEPT 771255
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2000
Mailing Address - Country:US
Mailing Address - Phone:313-271-3000
Mailing Address - Fax:313-271-3003
Practice Address - Street 1:16407 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101
Practice Address - Country:US
Practice Address - Phone:313-271-3000
Practice Address - Fax:313-271-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110Q264340OtherBCBSM
0Q26434Medicare ID - Type Unspecified