Provider Demographics
NPI:1073626701
Name:DEFILIPPO, DONNA (DO)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:DEFILIPPO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 874
Mailing Address - Street 2:
Mailing Address - City:EVART
Mailing Address - State:MI
Mailing Address - Zip Code:49631
Mailing Address - Country:US
Mailing Address - Phone:231-250-4148
Mailing Address - Fax:231-734-9949
Practice Address - Street 1:651 W MARION RD
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1027
Practice Address - Country:US
Practice Address - Phone:231-250-4148
Practice Address - Fax:231-734-9949
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55373-21208M00000X
MI5101013874207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4953852Medicaid
F710190OtherBCBS
MI4953852Medicaid
MIH34805Medicare UPIN