ST. CLAIR NEPHROLOGY, IDAHO NEPHROLOGY ASSOCIATES – NPI #1154361616
Internal Medicine

An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

Health Care Provider Taxonomy Code for Internal Medicine

ST. CLAIR NEPHROLOGY, IDAHO NEPHROLOGY ASSOCIATES is a provider located in ROSEVILLE, MI. NPPES has assigned the NPI number 1154361616 to ST. CLAIR NEPHROLOGY, IDAHO NEPHROLOGY ASSOCIATES on June 06, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “ST. CLAIR NEPHROLOGY, IDAHO NEPHROLOGY ASSOCIATES” is a dba name, the actual legal business name for this organization is ST CLAIR SPECIALTY PHYSICIANS PC. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207RN0300X from the Health Care Provider Taxonomy code set, which is classified as Internal Medicine, specializing in Nephrology

The NPI profile was previously updated about 4 years ago on Oct 17, 2022. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for ST. CLAIR NEPHROLOGY, IDAHO NEPHROLOGY ASSOCIATES below.

NPI Profile for
ST CLAIR SPECIALTY PHYSICIANS PC

NPI Number
1154361616
Enumeration Date

(more than 20 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
ST CLAIR SPECIALTY PHYSICIANS PC
Doing Business As (dba): ST. CLAIR NEPHROLOGY, IDAHO NEPHROLOGY ASSOCIATES
Primary location
18001 E 10 MILE RD
SUITE 1
ROSEVILLE, MI 48066-3803
Phone: (586) 218-5800 Fax: (586) 532-6496
Mailing address
45640 SCHOENHERR RD
SHELBY TOWNSHIP, MI 48315-6033
Phone: (586) 247-4300 Fax: (586) 532-6496
Organization Subpart
No
Authorized Official
CHRISTOPHER PROVENZANO
CEO/MANAGING EMPLOYEE (W2)
Phone: (586) 286-7800
Updated
Certification Date
Oct 17, 2022

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207RN0300X
- Internal Medicine / Nephrology (Primary)
2086S0129X
- Surgery / Vascular Surgery

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.