Provider Demographics
NPI:1891303061
Name:PFEFFERKORN MD PLLC
Entity Type:Organization
Organization Name:PFEFFERKORN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TASSIA
Authorized Official - Middle Name:ZOMA
Authorized Official - Last Name:PFEFFERKORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-860-8009
Mailing Address - Street 1:6490 BROCKHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46325 W 12 MILE RD STE 390
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2464
Practice Address - Country:US
Practice Address - Phone:248-719-7271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301100187OtherLARA