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General NPI Number Information
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NPI Number | 1750806469
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Entity Type | Individual
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Provider Name | DEMETRIUS KIRK RN
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Gender | Male
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 30075 SPAIN
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City | ROMULUS
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State | MI
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Zip | 48174
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Country | US
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Telephone | 313-595-9010
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Fax | 800-886-4196
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Provider Business Mailing Address
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Address Line | 30075 SPAIN ST
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City | ROMULUS
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State | MI
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Zip | 48174-3146
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Country | US
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Telephone | 313-595-9010
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Fax | 800-886-4196
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704326423
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License Number State | MI
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