Provider Demographics
NPI:1417085085
Name:CLARKSTON INTERNAL MEDICINE, P.C.
Entity Type:Organization
Organization Name:CLARKSTON INTERNAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-625-1600
Mailing Address - Street 1:7188 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1571
Mailing Address - Country:US
Mailing Address - Phone:248-625-1600
Mailing Address - Fax:248-625-0239
Practice Address - Street 1:7188 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-1571
Practice Address - Country:US
Practice Address - Phone:248-625-1600
Practice Address - Fax:248-625-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050183207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty