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General NPI Number Information
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NPI Number | 1881901668
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Entity Type | Organization
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Legal Business Name | DIVINE DIAGNOSTIC COMPANY
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 5005 E 14 MILE RD STE 100
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-6533
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Country | US
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Telephone | 586-795-3815
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Fax | 586-620-6062
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Provider Business Mailing Address
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Address Line | 5005 E 14 MILE RD STE 100
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-6533
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Country | US
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Telephone | 586-795-3815
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Fax | 586-620-6062
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MS. SUHA ALAKA
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Credential |
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Telephone | 586-713-8397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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