Provider Demographics
NPI: | 1639748734 |
---|---|
Name: | ADFINITAS HEALTH PALLIATIVE SERVICES OF MICHIGAN, PLLC |
Entity Type: | Organization |
Organization Name: | ADFINITAS HEALTH PALLIATIVE SERVICES OF MICHIGAN, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | AO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TIM |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DELBRUGGE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 301-693-8707 |
Mailing Address - Street 1: | 7250 PARKWAY DR STE 500 |
Mailing Address - Street 2: | |
Mailing Address - City: | HANOVER |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21076-1343 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 443-949-0814 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 850 W BARAGA AVE |
Practice Address - Street 2: | |
Practice Address - City: | MARQUETTE |
Practice Address - State: | MI |
Practice Address - Zip Code: | 49855-4550 |
Practice Address - Country: | US |
Practice Address - Phone: | 906-449-3000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-06-22 |
Last Update Date: | 2022-06-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RH0002X | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | Group - Multi-Specialty |