Provider Demographics
NPI:1386822518
Name:CAROL GORDON DEVORE MD PC
Entity Type:Organization
Organization Name:CAROL GORDON DEVORE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:DEVORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-594-1400
Mailing Address - Street 1:31815 SOUTHFIELD RD STE 16
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5471
Mailing Address - Country:US
Mailing Address - Phone:248-594-1400
Mailing Address - Fax:248-594-1404
Practice Address - Street 1:31815 SOUTHFIELD RD STE 16
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5471
Practice Address - Country:US
Practice Address - Phone:248-594-1400
Practice Address - Fax:248-594-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center