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General NPI Number Information
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NPI Number | 1275963019
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Entity Type | Organization
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Legal Business Name | DEANNA S MASTER MD PC
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 24110 MEADOWBROOK RD SUITE #100
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City | NOVI
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State | MI
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Zip | 48375-3459
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Country | US
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Telephone | 248-987-1119
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Fax | 248-987-1118
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Provider Business Mailing Address
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Address Line | 46274 PICKFORD ST
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City | NORTHVILLE
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State | MI
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Zip | 48168-1817
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Country | US
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Telephone | 248-380-2868
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Fax | 248-987-1118
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEANNA SUSAN MASTER
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Credential | M.D.
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Telephone | 248-380-2868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4301059342
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License Number State | MI
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