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General NPI Number Information
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NPI Number | 1043352784
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Entity Type | Organization
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Legal Business Name | DOWNRIVER INTERNISTS,P.C.
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 21801 GODDARD RD
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City | TAYLOR
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State | MI
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Zip | 48180-4213
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Country | US
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Telephone | 734-287-3830
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Fax | 737-287-4626
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Provider Business Mailing Address
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Address Line | 21801 GODDARD RD
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City | TAYLOR
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State | MI
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Zip | 48180-4213
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Country | US
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Telephone | 734-287-3830
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Fax | 734-287-4626
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. BEVERLY JEAN SMITH
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Credential | C.M.M.
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Telephone | 734-318-2418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 041891
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License Number State | MI
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