Healthcare Provider Details

I. General information

NPI: 1639394869
Provider Name (Legal Business Name): INFINITY PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26850 PROVIDENCE PKWY SUITE 375
NOVI MI
48374-1213
US

IV. Provider business mailing address

17197 N LAUREL PARK DR SUITE 540
LIVONIA MI
48152-2680
US

V. Phone/Fax

Practice location:
  • Phone: 248-662-4200
  • Fax: 248-662-0368
Mailing address:
  • Phone: 734-853-4901
  • Fax: 734-853-4900

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