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NPI Code Detail

MEDICARE: DR. ALICE DEA M.D.

MEDICARE: DR. ALICE DEA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207PE0004XEmergency Medical Services (Emergency Medicine) Physician4301048108MI
2207P00000XEmergency Medicine Physician4301048108MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AD048108OTHERMIBC/BS OF MI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073573366
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALICE DEA M.D.
Provider Business Mailing Address
First Line : 750 BERKSHIRE RD
Second Line :
City : GROSSE POINTE PARK
State : MI
Zip : 48230-1818
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3990 JOHN R ST
Second Line :
City : DETROIT
State : MI
Zip : 48201-2018
Country : US
Telephone Number : 313-745-8040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 06/18/2010

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Directions to “ DR. ALICE DEA M.D.” Practice Location

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