Provider Demographics
NPI:1437168234
Name:MASTER, DEANNA SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:SUSAN
Last Name:MASTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEANNA
Other - Middle Name:SUSAN
Other - Last Name:ASKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:24110 MEADOWBROOK RD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3459
Mailing Address - Country:US
Mailing Address - Phone:248-987-1119
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI7278OtherMEDICARE PTAN
MIMI7278OtherMEDICARE PTAN