Provider Demographics
NPI:1588688840
Name:DEBONO, DAVID J (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:DEBONO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1901 STAR BATT DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3712
Mailing Address - Country:US
Mailing Address - Phone:248-844-5690
Mailing Address - Fax:248-844-5691
Practice Address - Street 1:1901 STAR BATT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3712
Practice Address - Country:US
Practice Address - Phone:248-844-5690
Practice Address - Fax:248-844-5691
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036093118207RH0003X
MI4301093803207RH0002X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093118Medicaid
G36110Medicare UPIN
IL036093118Medicaid