Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Shelbydale Medical Clinic, PC

Organization Family Medicine Physician · NPI 1629258488

Shelbydale Medical Clinic, PC provides Family Medicine Physician services in Shelby Twp, Michigan. Licensed in Michigan. Registered with an NPI since 2007.

Licensed in
MI
In the registry since
2007
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

49221 Van Dyke Ave
Shelby Twp, MI 48317-1336 Not confirmed with CMS for 18 years — call before visiting
Phone: (586) 254-4860
Fax: (586) 254-5844
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence KT008999 (MI)

Record details

NPI number1629258488
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Keith Tom — President · (586) 254-4860
NPI enumeratedNovember 9, 2007
Last updated in NPPESNovember 9, 2007
Mailing address49221 Van Dyke Ave, Shelby Twp, MI 48317-1336

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