Provider Demographics
NPI:1396134755
Name:DEY, DILIP K (MHS, PT)
Entity type:Individual
Prefix:
First Name:DILIP
Middle Name:K
Last Name:DEY
Suffix:
Gender:M
Credentials:MHS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21102 PRESTWICK
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-4805
Mailing Address - Country:US
Mailing Address - Phone:248-476-1794
Mailing Address - Fax:248-476-1794
Practice Address - Street 1:19323 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1404
Practice Address - Country:US
Practice Address - Phone:248-471-1602
Practice Address - Fax:248-471-1674
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
30351OtherBLUE CROSS BLUE SHIELD
MI4306617Medicaid
236787Medicare Oscar/Certification