Provider Demographics
NPI:1568756773
Name:INFINITY PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:INFINITY PRIMARY CARE PLLC
Other - Org Name:INFINITY RIVER FAMILY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:DEIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-432-7581
Mailing Address - Street 1:PO BOX 673135
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-3135
Mailing Address - Country:US
Mailing Address - Phone:810-225-0900
Mailing Address - Fax:248-225-0909
Practice Address - Street 1:8641 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-4353
Practice Address - Country:US
Practice Address - Phone:810-225-0900
Practice Address - Fax:810-225-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP45200Medicare PIN