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SHELBYDALE MEDICAL CLINIC, P.C.
NPI 1629258488
Family Medicine in Shelby Twp, MI

Active since November 09, 2007CLIA 23D0868870 · Microscopy
49221 VAN DYKE AVE, SHELBY TWP, MI 48317(586) 254-4860(586) 254-5844 Get Directions Write a Review

NPPES record last updated: November 9, 2007. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Shelbydale Medical Clinic, P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHELBYDALE MEDICAL CLINIC, P.C. (NPI 1629258488) is a healthcare organization registered as a family medicine in Shelby Twp, Michigan and active in the NPI registry since November 2007. The organization holds a CLIA Microscopy certificate valid through June 8, 2028 and lists Keith B Tom, President, as its authorized official.

NPPES Registry Identity

NPI1629258488
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameSHELBYDALE MEDICAL CLINIC, P.C.
Location Address49221 VAN DYKE AVEShelby Twp, MI 48317-1336
Mailing Address49221 Van Dyke AveShelby Twp, MI 48317-1336 · (586) 254-4860 · Fax (586) 254-5844
Phone(586) 254-4860
Fax(586) 254-5844
Organization SubpartNo
Authorized OfficialKeith B TomPresident · (586) 254-4860
Enumeration DateNovember 9, 2007
✔ NPI 1629258488 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in MI · KT008999
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
49221 VAN DYKE AVE, Shelby Twp, MI 48317
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Other Identifiers 3

Medicaid2646558MI
Medicare PIN0P04980
Medicare UPINA77750

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Michigan Mutual Insurance Company.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 23D0868870

Shelbydale Medical Clinic PC · Shelby Township, MI
Active · expires Jun 8, 2028
CLIA Number23D0868870
Laboratory TypePhysician Office
Certificate Effective DateJune 9, 2026
Certificate Expiration DateJune 8, 2028
Laboratory DirectorKeith B. Tom
Laboratory Phone(586) 254-4860
Laboratory LocationShelbydale Medical Clinic PC49221 Van Dyke Road, Shelby Township, MI 48317
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shelbydale Medical Clinic, P.C.'s NPI number?

The NPI number for Shelbydale Medical Clinic, P.C. is 1629258488. It was assigned to this organization in the NPPES registry on November 9, 2007.

Where is Shelbydale Medical Clinic, P.C. located?

Shelbydale Medical Clinic, P.C. is located at 49221 Van Dyke Ave, Shelby Twp, MI 48317. The listed phone number is (586) 254-4860.

What is Shelbydale Medical Clinic, P.C.'s specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Shelbydale Medical Clinic, P.C. hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 23D0868870) is associated with this NPI, valid through June 8, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Shelbydale Medical Clinic, P.C. accept?

Health plans from Blue Cross Blue Shield of Michigan Mutual Insurance Company list Shelbydale Medical Clinic, P.C. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Shelbydale Medical Clinic, P.C. was last updated on November 9, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.