Provider Demographics
NPI:1598895427
Name:ALASDAIR MCKENDRICK, M.D., P.C.
Entity Type:Organization
Organization Name:ALASDAIR MCKENDRICK, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALASDAIR
Authorized Official - Middle Name:IL
Authorized Official - Last Name:MCKENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-380-8005
Mailing Address - Street 1:22250 PROVIDENCE DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4825
Mailing Address - Country:US
Mailing Address - Phone:248-557-8780
Mailing Address - Fax:248-557-3242
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:SUITE 208
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-557-8780
Practice Address - Fax:248-557-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM033769174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102712OtherCARE CHOICES
MI1360373OtherFIRST HEALTH
MI2806335721OtherBCBSM
MI101940OtherGREAT LAKES HEALTH
MI21874OtherOMNICARE
MI4262359OtherAETNA
MI791281006OtherRRMR
MI1011632001OtherWELLNESS PLAN
MI2836795-10Medicaid
MI9726331001OtherCIGNA
MIC3934OtherMCARE
MI1011632001OtherWELLNESS PLAN
MI101940OtherGREAT LAKES HEALTH