Provider Demographics
NPI:1831130723
Name:MICHIGAN KIDNEY CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:MICHIGAN KIDNEY CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-290-3111
Mailing Address - Street 1:PO BOX 77000 DEPARTMENT 771267
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-1267
Mailing Address - Country:US
Mailing Address - Phone:248-290-3111
Mailing Address - Fax:248-290-3100
Practice Address - Street 1:5280 METROPOLITAN PKWY
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4005
Practice Address - Country:US
Practice Address - Phone:248-290-3111
Practice Address - Fax:248-290-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M54550Medicare PIN
MI0N82600Medicare PIN