Healthcare Provider Details

I. General information

NPI: 1295997922
Provider Name (Legal Business Name): INFINITY PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S CANTON CENTER RD SUITE 220
CANTON MI
48188-1992
US

IV. Provider business mailing address

PO BOX 673135
DETROIT MI
48267-3135
US

V. Phone/Fax

Practice location:
  • Phone: 734-398-8790
  • Fax: 734-398-8680
Mailing address:
  • Phone: 734-464-8300
  • Fax: 734-464-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN G DEIGHTON
Title or Position: PRESIDENT
Credential: MD
Phone: 734-432-7581