| Michigan Infectious Disease Consultants Pc | |
|
44200 Woodward Ave Suite 101 Pontiac MI 48341-5046 | |
| (248) 212-0678 | |
| (248) 212-0790 |
| Full Name | Michigan Infectious Disease Consultants Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 44200 Woodward Ave, Pontiac, Michigan |
| Authorized Official Name and Position | Shamla A Kalyan (OWNER) |
| Authorized Official Contact | 2482120678 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michigan Infectious Disease Consultants Pc 4920 Adams Pointe Ct Troy MI 48098-4111 Ph: (248) 212-0678 | Michigan Infectious Disease Consultants Pc 44200 Woodward Ave Suite 101 Pontiac MI 48341-5046 Ph: (248) 212-0678 |
| NPI Number | 1699934554 |
|---|---|
| Provider Enumeration Date | 06/05/2008 |
| Last Update Date | 09/26/2014 |
| Medicare PECOS PAC ID | 6507931755 |
|---|---|
| Medicare Enrollment ID | O20080822000109 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699934554 | NPI | - | NPPES |
| 440F306450 | Other | MI | BCS |
| 1106366471 | Other | MI | BCN |
| 1106366471 | Other | MI | BCBS |
| 4717980 | Medicaid | MI | |
| 1699934554 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Shamla Kalyan |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1043237951 PECOS PAC ID: 1557333895 Enrollment ID: I20040809000356 |
| Provider Name | Suresha C Bandara |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1841457454 PECOS PAC ID: 3476749680 Enrollment ID: I20101130001273 |
| Provider Name | Verna R Dubord |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487195566 PECOS PAC ID: 7719255223 Enrollment ID: I20170623001459 |
| Provider Name | Amar Krishna |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1710234018 PECOS PAC ID: 0840598835 Enrollment ID: I20240320002491 |
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