Healthcare Provider Details

I. General information

NPI: 1417160698
Provider Name (Legal Business Name): DOWNRIVER INTERNAL MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 KING RD STE A
RIVERVIEW MI
48193-7909
US

IV. Provider business mailing address

14700 KING RD STE A
RIVERVIEW MI
48193-7909
US

V. Phone/Fax

Practice location:
  • Phone: 734-479-1944
  • Fax: 734-479-1253
Mailing address:
  • Phone: 734-479-1944
  • Fax: 734-479-1253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LYNETTE HINDS
Title or Position: OFFICE MANAGER
Credential:
Phone: 734-479-1944