MEDICARE: DR. DEREK PFLUM D.D.S.

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
1	1223G0001X	General Practice Dentistry	2901021698	MI

General Provider Information

NPI Number	:	1245616507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEREK PFLUM D.D.S.

Provider Business Mailing Address
First Line	:	529 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-4324
Country	:	US
Telephone Number	:	313-879-4769
Fax Number	:

Provider Business Practice Location Address
First Line	:	529 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-4324
Country	:	US
Telephone Number	:	313-879-4769
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2015
Last Update Date	:	08/09/2015

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