Provider Demographics
NPI:1508647363
Name:DTG II PLLC
Entity Type:Organization
Organization Name:DTG II PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:KANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-795-2361
Mailing Address - Street 1:811 E KENT RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-9791
Mailing Address - Country:US
Mailing Address - Phone:800-268-7713
Mailing Address - Fax:415-704-3294
Practice Address - Street 1:821 N ST STE 102
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3285
Practice Address - Country:US
Practice Address - Phone:800-268-7713
Practice Address - Fax:415-704-3294
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DTG II PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty