Detolve, Geoffrey R

Detolve, Geoffrey R is an individual health care provider with primary practice located at 601 John St Suite E352, Kalamazoo MI 49007-5341. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Detolve, Geoffrey R can be contacted via phone (269) 341-8986.

Contact Information

Primary practice address
601 John St Suite E352 Kalamazoo MI 49007-5341
Phone: (269) 341-8986
Fax: (269) 341-6236
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 4301064382 Michigan

Profile Details

NPI number 1184604795
LBN Legal business name Detolve, Geoffrey R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 19th, 2006
Last updated Nov 17th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184604795 NPPES
Michigan MEDICAID 1184604795
Michigan MEDICAID 4385657
Michigan Other 1417961137

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