Provider Demographics
NPI:1063486736
Name:MERMIGES, DEMETRIOS (MD)
Entity Type:Individual
Prefix:DR
First Name:DEMETRIOS
Middle Name:
Last Name:MERMIGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19611 E 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1655
Mailing Address - Country:US
Mailing Address - Phone:586-772-6850
Mailing Address - Fax:586-772-3810
Practice Address - Street 1:19611 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1655
Practice Address - Country:US
Practice Address - Phone:586-772-6850
Practice Address - Fax:586-772-3810
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI038263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4390577Medicaid
MIB48195Medicare UPIN
MION33430Medicare ID - Type Unspecified