Provider Demographics
NPI:1245744242
Name:MAUREEN CLIFFEL DO PLLC
Entity Type:Organization
Organization Name:MAUREEN CLIFFEL DO PLLC
Other - Org Name:DETROIT DERMATOLOGY AND VEIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIFFEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-965-2919
Mailing Address - Street 1:26454 WOODWARD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-0969
Mailing Address - Country:US
Mailing Address - Phone:248-965-2919
Mailing Address - Fax:248-965-2905
Practice Address - Street 1:26454 WOODWARD AVE STE 200
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0969
Practice Address - Country:US
Practice Address - Phone:248-965-2919
Practice Address - Fax:248-965-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015453207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty