Provider Demographics
NPI:1487608014
Name:NEPHROLOGY CONSULTANTS, PC
Entity type:Organization
Organization Name:NEPHROLOGY CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PEYTON
Authorized Official - Last Name:SPECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:247-414-5377
Mailing Address - Street 1:27901 WOODWARD AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-0919
Mailing Address - Country:US
Mailing Address - Phone:248-414-5377
Mailing Address - Fax:248-541-0542
Practice Address - Street 1:27901 WOODWARD AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0919
Practice Address - Country:US
Practice Address - Phone:248-414-5377
Practice Address - Fax:248-541-0542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M04580Medicare ID - Type Unspecified