Healthcare Provider Details

I. General information

NPI: 1710705595
Provider Name (Legal Business Name): DEMETRIUS ROBINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17242 EVERGREEN RD
DETROIT MI
48219-3400
US

IV. Provider business mailing address

17242 EVERGREEN RD
DETROIT MI
48219-3400
US

V. Phone/Fax

Practice location:
  • Phone: 313-433-9777
  • Fax:
Mailing address:
  • Phone: 313-433-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: