Healthcare Provider Details

I. General information

NPI: 1689188765
Provider Name (Legal Business Name): HILL & DESIRE HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 OWEN ST
BELLEVILLE MI
48111-2921
US

IV. Provider business mailing address

25 OWEN ST
BELLEVILLE MI
48111-2921
US

V. Phone/Fax

Practice location:
  • Phone: 734-699-5400
  • Fax: 734-699-5455
Mailing address:
  • Phone: 734-699-5400
  • Fax: 734-699-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601004307
License Number StateMI

VIII. Authorized Official

Name: DEODGE MONIQUE HILL
Title or Position: CEO/ OWNER
Credential: PA
Phone: 313-475-8896