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General NPI Number Information
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NPI Number | 1386822518
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Entity Type | Organization
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Legal Business Name | CAROL GORDON DEVORE MD PC
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 31815 SOUTHFIELD RD STE 16
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City | BEVERLY HILLS
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State | MI
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Zip | 48025-5471
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Country | US
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Telephone | 248-594-1400
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Fax | 248-594-1404
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Provider Business Mailing Address
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Address Line | 31815 SOUTHFIELD RD STE 16
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City | BEVERLY HILLS
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State | MI
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Zip | 48025-5471
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Country | US
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Telephone | 248-594-1400
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Fax | 248-594-1404
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CAROL GORDON DEVORE
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Credential | MD
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Telephone | 248-594-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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