Provider Demographics
NPI:1255327490
Name:CLUNE, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:CLUNE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:25511 LITTLE MACK AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3372
Mailing Address - Country:US
Mailing Address - Phone:586-774-2020
Mailing Address - Fax:586-774-3169
Practice Address - Street 1:25511 LITTLE MACK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3372
Practice Address - Country:US
Practice Address - Phone:586-774-2020
Practice Address - Fax:586-774-3169
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301054473207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
N93750002Medicare PIN
MIF61621Medicare UPIN