Provider Demographics
NPI:1376667634
Name:DENNIS C. PACKEY, DO PC
Entity type:Organization
Organization Name:DENNIS C. PACKEY, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:PACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-886-0600
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDP006508207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114836829Medicaid
MI1158213614OtherBCBS PIN
MI114836838Medicaid
MI114836838Medicaid
MI1158213614OtherBCBS PIN