Provider Demographics
NPI:1821089236
Name:PACKEY, DENNIS C (DO)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:C
Last Name:PACKEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20867 MACK AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1392
Mailing Address - Country:US
Mailing Address - Phone:313-886-0600
Mailing Address - Fax:313-886-0612
Practice Address - Street 1:20867 MACK AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1392
Practice Address - Country:US
Practice Address - Phone:313-886-0600
Practice Address - Fax:313-886-0612
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101006508207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5101006508OtherCONTROLLED SUBSTANCE
MI4836838Medicaid
MI4836829Medicaid
MI4836829Medicaid
0P26060Medicare PIN
5101006508OtherCONTROLLED SUBSTANCE