Provider Demographics
NPI:1528194545
Name:WELDON, CLIFFORD (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:WELDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15945 19 MILE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1147
Mailing Address - Country:US
Mailing Address - Phone:313-608-0254
Mailing Address - Fax:
Practice Address - Street 1:15945 19 MILE RD STE 202
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1147
Practice Address - Country:US
Practice Address - Phone:586-285-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054557207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM-006492OtherTRICARE
MIQMXPR0020661OtherMOLINA
MI0500966OtherBCBSM
MI7001298OtherCHAMPS
MI0166726OtherTOTAL HEALTHCARE
MICW054557OtherLICENSE
P87524OtherBCN
MI1528194545Medicaid
MI21606OtherOMNICARE
P87524OtherBCN
MICW054557OtherLICENSE