1477101392 NPI number — COMPREHENSIVE INFECTIOUS DISEASES CONSULTANTS PLLC

Table of content: (NPI 1477101392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477101392 NPI number — COMPREHENSIVE INFECTIOUS DISEASES CONSULTANTS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE INFECTIOUS DISEASES CONSULTANTS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1477101392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17177 N LAUREL PARK DR STE 439
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48152-3938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-462-0340
Provider Business Mailing Address Fax Number:
734-462-0344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18451 W 12 MILE RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATHRUP VILLAGE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48076-2635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-832-2255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/04/2019

Additional Information

Authorized Official

Authorized Official Last Name:
DEMARCO
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-832-2255

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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