Provider Demographics
NPI:1548557978
Name:CLAWSON MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:CLAWSON MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REPRESENTATIVE
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZELCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-543-6400
Mailing Address - Street 1:1224 W 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1494
Mailing Address - Country:US
Mailing Address - Phone:248-280-1600
Mailing Address - Fax:248-543-3007
Practice Address - Street 1:1224 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1494
Practice Address - Country:US
Practice Address - Phone:248-280-1600
Practice Address - Fax:248-543-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty