Provider Demographics
NPI:1275963019
Name:DEANNA S MASTER MD PC
Entity Type:Organization
Organization Name:DEANNA S MASTER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:MASTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-380-2868
Mailing Address - Street 1:46274 PICKFORD ST
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-1817
Mailing Address - Country:US
Mailing Address - Phone:248-380-2868
Mailing Address - Fax:248-987-1118
Practice Address - Street 1:24110 MEADOWBROOK RD
Practice Address - Street 2:SUITE #100
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3459
Practice Address - Country:US
Practice Address - Phone:248-987-1119
Practice Address - Fax:248-987-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059342261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG42402Medicare UPIN