Provider Demographics
NPI:1558340356
Name:CLINTON, JAMES E (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:CLINTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18645 CANAL RD
Mailing Address - Street 2:STE 5
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5822
Mailing Address - Country:US
Mailing Address - Phone:586-264-4261
Mailing Address - Fax:586-264-4707
Practice Address - Street 1:18645 CANAL RD
Practice Address - Street 2:STE 5
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5822
Practice Address - Country:US
Practice Address - Phone:586-264-4261
Practice Address - Fax:586-264-4707
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4632524Medicaid
MIE95591Medicare UPIN
MI4632524Medicaid