Provider Demographics
NPI:1093956799
Name:KIDNEY & HYPERTENSION CENTER P.C
Entity type:Organization
Organization Name:KIDNEY & HYPERTENSION CENTER P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEPHROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MISHACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-228-6603
Mailing Address - Street 1:43171 DALCOMA DR STE 9
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6307
Mailing Address - Country:US
Mailing Address - Phone:586-228-6603
Mailing Address - Fax:586-228-6613
Practice Address - Street 1:43171 DALCOMA DR STE 9
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6307
Practice Address - Country:US
Practice Address - Phone:586-228-6603
Practice Address - Fax:586-228-6613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty