Provider Demographics
NPI:1821740465
Name:DELPHI DIALYSIS CORPORATION
Entity Type:Organization
Organization Name:DELPHI DIALYSIS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BONIFACE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TUBIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-395-2206
Mailing Address - Street 1:20755 GREENFIELD RD STE 203
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5405
Mailing Address - Country:US
Mailing Address - Phone:248-395-2206
Mailing Address - Fax:248-395-0456
Practice Address - Street 1:20755 GREENFIELD RD STE 203
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5405
Practice Address - Country:US
Practice Address - Phone:248-395-2206
Practice Address - Fax:248-395-0456
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELTA RENAL GROUP, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty