Healthcare Provider Details

I. General information

NPI: 1366550105
Provider Name (Legal Business Name): D-CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25932 DEQUINDRE RD SUITE C
WARREN MI
48091-1071
US

IV. Provider business mailing address

25932 DEQUINDRE RD SUITE C
WARREN MI
48091-1071
US

V. Phone/Fax

Practice location:
  • Phone: 248-726-0127
  • Fax: 586-486-5552
Mailing address:
  • Phone: 248-726-0127
  • Fax: 586-486-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. THEODORE RICHARD DENSLEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-275-5221