Healthcare Provider Details

I. General information

NPI: 1851656383
Provider Name (Legal Business Name): DEANNA DENYSENKO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30061 SCHOENHERR RD SUITE A
WARREN MI
48088-3133
US

IV. Provider business mailing address

30061 SCHOENHERR RD SUITE A
WARREN MI
48088-3133
US

V. Phone/Fax

Practice location:
  • Phone: 586-558-2111
  • Fax: 586-558-3665
Mailing address:
  • Phone: 586-558-2111
  • Fax: 586-558-3663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101020135
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: