Healthcare Provider Details

I. General information

NPI: 1689885535
Provider Name (Legal Business Name): DEON D MIDDLEBROOK M D PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20176 LIVERNOIS AVE
DETROIT MI
48221-1346
US

IV. Provider business mailing address

20176 LIVERNOIS AVE
DETROIT MI
48221-1346
US

V. Phone/Fax

Practice location:
  • Phone: 313-864-3000
  • Fax: 313-864-5423
Mailing address:
  • Phone: 313-864-7000
  • Fax: 313-864-5769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License NumberDM053010
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEON MIDDLEBROOK
Title or Position: PRESIDENT
Credential:
Phone: 313-864-7000