Provider Demographics
NPI:1730304965
Name:INFINITY PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:INFINITY PRIMARY CARE, PLLC
Other - Org Name:ASSOCIATES IN INTERNAL MEDICINE
Other - Org Type:Doing Business As
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 1:17197 N LAUREL PARK DR
Mailing Address - Street 2:SUITE 540
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2680
Mailing Address - Country:US
Mailing Address - Phone:734-853-4901
Mailing Address - Fax:734-853-4900
Practice Address - Street 1:5777 W MAPLE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2267
Practice Address - Country:US
Practice Address - Phone:248-406-1000
Practice Address - Fax:248-406-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110F323720OtherBCBSM
0N91620Medicare ID - Type Unspecified