Provider Demographics
NPI:1912228743
Name:CLIFFORD L WELDON M D P L C
Entity Type:Organization
Organization Name:CLIFFORD L WELDON M D P L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WELDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-285-9270
Mailing Address - Street 1:30695 LITTLE MACK AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-1772
Mailing Address - Country:US
Mailing Address - Phone:586-285-9270
Mailing Address - Fax:586-285-9271
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:586-285-9271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICW054557207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQMXPR0020661OtherMOLINA
MI0500966OtherBCBSM
MICW054557OtherLICENSE
MI7001298OtherCHAMPS
MIM-006492OtherTRICARE
MIP87524OtherBCN
MI0166726OtherTOTAL HEALTHCARE
MI1528194545Medicaid
MI21606OtherOMNICARE
MIP87524OtherBCN
MICW054557OtherLICENSE