| Divi MD PC | |
|
20755 Greenfield Rd Ste #1004 Southfield MI 48075-5403 | |
| (248) 424-5090 | |
| (248) 424-5091 |
| Full Name | Divi MD PC |
|---|---|
| Speciality | Family Medicine |
| Location | 20755 Greenfield Rd, Southfield, Michigan |
| Authorized Official Name and Position | Thulasi S Divi (OWNER/PRESIDENT) |
| Authorized Official Contact | 2485281555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Divi MD PC 20755 Greenfield Road Ste # 1004 Southfield MI 48075-5411 Ph: (248) 424-5090 | Divi MD PC 20755 Greenfield Rd Ste #1004 Southfield MI 48075-5403 Ph: (248) 424-5090 |
| NPI Number | 1972527026 |
|---|---|
| Provider Enumeration Date | 07/26/2006 |
| Last Update Date | 12/14/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972527026 | NPI | - | NPPES |
| 23D0988999 | Other | MI | CLIA CERTIFICATE |
| 4226454 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 4301062122 (Michigan) | Primary |
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