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General NPI Number Information
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NPI Number | 1437168234
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Entity Type | Individual
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Provider Name | DEANNA SUSAN MASTER MD
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 11/05/2014
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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 | 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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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301059342
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License Number State | MI
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