JEFFREY LOUIS PROVIZER (NPI# 1316931405) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316931405 |
| Entity Type | Individual |
| Full Name | JEFFREY LOUIS PROVIZER |
| Credential | DO |
| Practice Address |
32255 Northwestern Hwy Ste 130 Farmington Hills MI 48334 |
| Mailing Address |
29992 Northwestern Hwy Ste C Farmington Hills MI 48334-3292 |
| Practice Telephone | 2487235880 |
| Practice Fax Number | 2487235889 |
| Mailing Telephone | 2488511430 |
| Mailing Fax Number | 2488515182 |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2018-12-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 5101013058 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1316931405 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4123 Martin Rd Ste 102, Commerce Twp, MI 483904151 | 2483663700 | 2483601760 |
| 620 N Pontiac Trl, Walled Lake, MI 483903443 | 2486244511 | 2486244408 |
| Street Address |
32255 NORTHWESTERN HWY STE 130 |
| City | FARMINGTON HILLS |
| State | MI |
| Zip Code | 48334 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164056313 | Taylor Renee Heimke | Nurse Practitioner | 32255 Northwestern Hwy Ste 130, Farmington Hills, MI 48334-1505 | 2020-02-26 |
| 1215377791 | Ryan Scott Wolok | Internal Medicine | 32255 Northwestern Hwy Ste 130, Farmington Hills, MI 48334-1505 | 2013-06-28 |
| 1851376941 | Erno Berdy | Internal Medicine | 32255 Northwestern Hwy Ste 130, Farmington Hills, MI 48334-1505 | 2005-12-12 |
| 1306836390 | Harvey P Sabbota | Internal Medicine | 32255 Northwestern Hwy Ste 130, Farmington Hills, MI 48334-1505 | 2005-10-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588264535 | Kiah Bradley | Behavior Technician | 2777 Inkster Rd Suite 100, Farmington Hills, MI 48334 | 2020-10-29 |
| 1417557307 | Carsen D Dresbach | Behavior Technician | 2777 Inster Road Suite 100, Farmington Hills, MI 48334 | 2020-10-29 |
| 1316560303 | Amy K Pruneau LLC | Psychologist | 26755 Middlebelt Rd Ste 140, Farmington Hills, MI 48334 | 2020-05-25 |
| 1366089732 | Vian Aljony | Dental Hygienist | 27273 Arden Park Cir, Farmington Hills, MI 48334 | 2019-12-04 |
| 1699311902 | Sandra Zori | Pharmacist | 27800 Middlebelt Rd, Farmington Hills, MI 48334 | 2019-11-21 |
| 1902450471 | Kianna Marie Garcia | Behavior Technician | 27777 Inkster Rd., Farmington Hills, MI 48334 | 2019-08-01 |
| 1619521176 | Samantha Serra | Behavior Technician | 27777 Inkster Rd Suite 100, Farmington Hills, MI 48334 | 2019-08-01 |
| 1851945398 | Kristen Butler | Behavior Technician | 27777 Inkster Road Suite 100, Farmington Hills, MI 48334 | 2019-08-01 |
| 1104489038 | Katherine Kalsow | Behavioral Analyst | 27777 Inkster Rd. Suite 100, Farmington Hills, MI 48334 | 2019-04-16 |
| 1083178487 | Imee Raterta | Physical Therapist | Ability Works Rehab, 28592 Orchard Lake Rd # 300, Farmington Hills, MI 48334 | 2019-01-30 |
| Find all providers in zip 48334 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407416357 | Vishesha Patel | Family Medicine | 28050 Grand River Ave Ste 313, Farmington Hills, MI 48336-5919 | 2019-06-13 |
| 1194232462 | Lifeline Sciences LLC | Family Medicine | 32000 Northwestern Hwy Ste 240, Farmington Hills, MI 48334-1569 | 2018-01-08 |
| 1720466790 | Jason Hawkins | Family Medicine | 35984 Quakertown Ln, Farmington Hills, MI 48331-3807 | 2015-05-11 |
| 1922406974 | Twaide Langham | Family Medicine | 28284 Golf Pointe Blvd, Farmington Hills, MI 48331-2937 | 2014-12-08 |
| 1811317878 | Annie L Craib | Family Medicine | 28100 Grand River Ave Ste 313, Farmington Hills, MI 48336-5970 | 2014-04-17 |
| 1619306404 | Ami Medical Associates Pllc | Family Medicine | 31313 Northwestern Hwy Ste 203, Farmington Hills, MI 48334-2577 | 2013-11-02 |
| 1467792564 | William John Powers | Family Medicine | 23700 Orchard Lake Rd Ste E, Farmington Hills, MI 48336-2559 | 2013-02-26 |
| 1598040701 | Freydoon M Eskandari | Family Medicine | 27906 Old Colony St, Farmington Hills, MI 48334-3243 | 2011-10-19 |
| 1669600219 | Mark Korea Banno | Family Medicine | 27970 Orchard Lake Rd Ste 1, Farmington Hills Medical Group, Farmington Hills, MI 48334-3767 | 2009-06-22 |
| 1164669024 | Thomas Joseph Ruane | Family Medicine | 26509 Old Homestead Ct, Farmington Hills, MI 48331-3851 | 2009-01-14 |
| Find all providers in FARMINGTON HILLS | ||||
| City | FARMINGTON HILLS |
| Zip Code | 48334 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.