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General NPI Number Information
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NPI Number | 1639264344
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY MEDICAL CLINIC, P.C.
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 37450 DEQUINDRE RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-3503
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Country | US
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Telephone | 586-979-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 37450 DEQUINDRE RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-3503
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Country | US
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Telephone | 586-979-5100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY DEITCH
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Credential | D.O.
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Telephone | 586-979-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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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 | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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