Provider Demographics
NPI:1225363203
Name:DIVINE MEDICAL CARE
Entity Type:Organization
Organization Name:DIVINE MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKE
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:313-393-3141
Mailing Address - Street 1:2141 E JEFFERSON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4128
Mailing Address - Country:US
Mailing Address - Phone:313-393-3141
Mailing Address - Fax:313-393-3144
Practice Address - Street 1:2141 E JEFFERSON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4128
Practice Address - Country:US
Practice Address - Phone:313-393-3141
Practice Address - Fax:313-393-3144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center