Provider Demographics
NPI:1225696404
Name:PYYKKONEN, DEVON J
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:J
Last Name:PYYKKONEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 LAKE ANGELUS SHRS
Mailing Address - Street 2:
Mailing Address - City:LAKE ANGELUS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-1039
Mailing Address - Country:US
Mailing Address - Phone:248-762-4280
Mailing Address - Fax:
Practice Address - Street 1:28050 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5919
Practice Address - Country:US
Practice Address - Phone:947-521-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151013673APP19207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine