Provider Demographics
NPI:1790776946
Name:DEMETRIOU, DEMETRIS M (MD)
Entity Type:Individual
Prefix:DR
First Name:DEMETRIS
Middle Name:M
Last Name:DEMETRIOU
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:29645 W 14 MILE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1666
Mailing Address - Country:US
Mailing Address - Phone:248-932-3700
Mailing Address - Fax:248-932-0958
Practice Address - Street 1:29645 W 14 MILE RD
Practice Address - Street 2:STE 200
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1666
Practice Address - Country:US
Practice Address - Phone:248-932-3700
Practice Address - Fax:248-932-0958
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301058034207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4270452Medicaid
0F36003015Medicare ID - Type Unspecified
MI4270452Medicaid