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General NPI Number Information
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NPI Number | 1306395546
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Entity Type | Organization
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Legal Business Name | DEFPOTEC CORPORATION
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Dates
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Enumeration Date | 09/29/2016
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 17260 W 10 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2949
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Country | US
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Telephone | 248-809-4633
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Fax |
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Provider Business Mailing Address
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Address Line | 14200 W 8 MILE RD 37047
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City | OAK PARK
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State | MI
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Zip | 48237-7700
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Country | US
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Telephone | 313-455-4146
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MS. KRISTIE VOLAURA LEE
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Credential |
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Telephone | 248-595-8271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 132700000X
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Taxonomy Name | Dietary Manager
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WG0600X
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Taxonomy Name | Gerontology Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WP0000X
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Taxonomy Name | Pain Management Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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