Provider Demographics
NPI:1285974790
Name:SAINT JOSEPH CLINIC PC
Entity type:Organization
Organization Name:SAINT JOSEPH CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SRINIVASULU
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-809-6402
Mailing Address - Street 1:23077 GREENFIELD RD
Mailing Address - Street 2:SUITE#240
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3709
Mailing Address - Country:US
Mailing Address - Phone:248-809-6402
Mailing Address - Fax:248-537-3012
Practice Address - Street 1:23077 GREENFIELD RD
Practice Address - Street 2:SUITE#240
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3709
Practice Address - Country:US
Practice Address - Phone:248-809-6402
Practice Address - Fax:248-537-3012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT JOSEPH CLINIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty