Healthcare Provider Details

I. General information

NPI: 1700756137
Provider Name (Legal Business Name): DESHAWN GROVES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 OAKMAN BLVD
DETROIT MI
48238-3710
US

IV. Provider business mailing address

42405 NORTHVILLE PLACE DR APT 119
NORTHVILLE MI
48167-3185
US

V. Phone/Fax

Practice location:
  • Phone: 888-360-9355
  • Fax: 888-360-9355
Mailing address:
  • Phone: 269-873-3233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberG612139019364
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: