Provider Demographics
NPI:1194174615
Name:DEITCH, DORIN (DO)
Entity type:Individual
Prefix:DR
First Name:DORIN
Middle Name:
Last Name:DEITCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42350 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1838
Mailing Address - Country:US
Mailing Address - Phone:248-697-2942
Mailing Address - Fax:248-436-6628
Practice Address - Street 1:42350 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1838
Practice Address - Country:US
Practice Address - Phone:248-697-2942
Practice Address - Fax:248-436-6628
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101022597208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation