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NPI Code Detail

MEDICARE: KORY V. DEASON M.D.

MEDICARE: KORY V. DEASON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician4301044811MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23900122OTHERMIPHYSICIANS HEALTH PLAN
3KD044811OTHERMIBCBS
43970122OTHERMIPHP FAMILY CARE
5P105859OTHERMIBLUE CARE NETWORK

General Provider Information

NPI Number : 1588603922
Entity Type Code : Individual
Provider Name (Legal Business Name) : KORY V. DEASON M.D.
Provider Business Mailing Address
First Line : 321 E HARRIS ST
Second Line :
City : CHARLOTTE
State : MI
Zip : 48813-1629
Country : US
Telephone Number : 517-543-1050
Fax Number : 517-543-0875
Provider Business Practice Location Address
First Line : 321 E HARRIS ST
Second Line :
City : CHARLOTTE
State : MI
Zip : 48813-1629
Country : US
Telephone Number : 517-543-1050
Fax Number : 517-543-0875
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2006
Last Update Date : 07/08/2007

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