Provider Demographics
NPI:1942277397
Name:DEIGHTON, KEVIN G (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:G
Last Name:DEIGHTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:33523 8 MILE RD
Mailing Address - Street 2:STE M2
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4119
Mailing Address - Country:US
Mailing Address - Phone:734-432-7581
Mailing Address - Fax:734-853-5698
Practice Address - Street 1:37595 7 MILE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1003
Practice Address - Country:US
Practice Address - Phone:734-432-7581
Practice Address - Fax:734-853-5698
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2019-03-26
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Provider Licenses
StateLicense IDTaxonomies
MI4301051389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4619120Medicaid
MI4619120Medicaid
N91620041Medicare ID - Type Unspecified