Provider Demographics
NPI:1285335265
Name:UPTIV HEALTH MI PC
Entity type:Organization
Organization Name:UPTIV HEALTH MI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. OPS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANKIE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DEJESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-430-7119
Mailing Address - Street 1:5543 EDMONDSON PIKE STE 162
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5808
Mailing Address - Country:US
Mailing Address - Phone:734-203-0176
Mailing Address - Fax:888-373-5528
Practice Address - Street 1:36585 WARREN RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2999
Practice Address - Country:US
Practice Address - Phone:734-203-0176
Practice Address - Fax:888-373-5528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty