Healthcare Provider Details

I. General information

NPI: 1639264344
Provider Name (Legal Business Name): TRI-COUNTY MEDICAL CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37450 DEQUINDRE RD
STERLING HEIGHTS MI
48310-3503
US

IV. Provider business mailing address

37450 DEQUINDRE RD
STERLING HEIGHTS MI
48310-3503
US

V. Phone/Fax

Practice location:
  • Phone: 586-979-5100
  • Fax:
Mailing address:
  • Phone: 586-979-5100
  • Fax:

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 Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY DEITCH
Title or Position: PRESIDENT
Credential: D.O.
Phone: 586-979-5100