Provider Demographics
NPI:1306395546
Name:DEFPOTEC CORPORATION
Entity Type:Organization
Organization Name:DEFPOTEC CORPORATION
Other - Org Name:DEFPOTEC CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:VOLAURA
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-595-8271
Mailing Address - Street 1:14200 W 8 MILE RD
Mailing Address - Street 2:37047
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-7700
Mailing Address - Country:US
Mailing Address - Phone:313-455-4146
Mailing Address - Fax:
Practice Address - Street 1:17260 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2949
Practice Address - Country:US
Practice Address - Phone:248-809-4633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305S00000XManaged Care OrganizationsPoint of Service
No132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Multi-Specialty
No163WG0600XNursing Service ProvidersRegistered NurseGerontologyGroup - Multi-Specialty
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty