Healthcare Provider Details

I. General information

NPI: 1609998095
Provider Name (Legal Business Name): INFINITY PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28455 HAGGERTY RD SUITE 102
NOVI MI
48377-2982
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 248-553-0050
  • Fax: 248-553-7899
Mailing address:
  • Phone: 734-853-4901
  • Fax: 734-853-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 6
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: 734-853-4901