Provider Demographics
NPI:1528232543
Name:D.A.KREVSKY,M.D.P.C.
Entity Type:Organization
Organization Name:D.A.KREVSKY,M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:KREVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-386-1100
Mailing Address - Street 1:8449 PARK AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1594
Mailing Address - Country:US
Mailing Address - Phone:313-386-1100
Mailing Address - Fax:313-386-3554
Practice Address - Street 1:8449 PARK AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1594
Practice Address - Country:US
Practice Address - Phone:313-386-1100
Practice Address - Fax:313-386-3554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2018407Medicaid