Provider Demographics
NPI:1790925352
Name:DIVINTY VISITING PHYSICIANS
Entity Type:Organization
Organization Name:DIVINTY VISITING PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHANSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-539-4640
Mailing Address - Street 1:18597 W 10 MILE RD
Mailing Address - Street 2:SUITE 05
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2663
Mailing Address - Country:US
Mailing Address - Phone:248-423-2988
Mailing Address - Fax:248-423-2922
Practice Address - Street 1:31513 NORTHWESTERN HWY
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2528
Practice Address - Country:US
Practice Address - Phone:248-539-4640
Practice Address - Fax:248-539-4645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty