MEDICARE: DR. DEON DAVID MIDDLEBROOK MD

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	174400000X	Specialist	DM053010	MI
2	207RN0300X	Nephrology Physician	4301053010	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508898123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEON DAVID MIDDLEBROOK MD

Provider Business Mailing Address
First Line	:	20176 LIVERNOIS AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-1346
Country	:	US
Telephone Number	:	313-864-7000
Fax Number	:	313-864-5769

Provider Business Practice Location Address
First Line	:	20176 LIVERNOIS AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-1346
Country	:	US
Telephone Number	:	313-864-7000
Fax Number	:	313-864-5423

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	03/17/2026

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