Provider Demographics
NPI:1881644888
Name:JAMES H DEERING DO PC
Entity type:Organization
Organization Name:JAMES H DEERING DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:DEERING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-449-7103
Mailing Address - Street 1:8232 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0001
Mailing Address - Country:US
Mailing Address - Phone:248-668-3085
Mailing Address - Fax:
Practice Address - Street 1:1457 N M 52
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1234
Practice Address - Country:US
Practice Address - Phone:989-725-7512
Practice Address - Fax:989-725-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0996086OtherHEALTHPLUS
MIJD007504OtherLICENSE NUMBER
MIRA780001OtherM-CARE
E4224OtherRAILROAD MEDICARE
MIMI0011320OtherTRICARE/CHAMPUS
MI0G86079Medicare ID - Type Unspecified