Basic Information
Provider Information
NPI: 1629280672
EntityType: 2
ReplacementNPI:  
OrganizationName: INFINITY PRIMARY CARE, PLLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
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Credential:  
OtherOrganizationName: IPC BRIGHTON FAMILY PRACTICE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
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Mailing Information
Address1: 17197 N LAUREL PARK DR
Address2: SUITE 540
City: LIVONIA
State: MI
PostalCode: 481522680
CountryCode: US
TelephoneNumber: 7348534901
FaxNumber: 7348534900
Practice Location
Address1: 7575 GRAND RIVER RD
Address2: SUITE 209
City: BRIGHTON
State: MI
PostalCode: 481149309
CountryCode: US
TelephoneNumber: 8108447950
FaxNumber: 8108447955
Other Information
ProviderEnumerationDate: 05/03/2007
LastUpdateDate: 03/24/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DEIGHTON
AuthorizedOfficialFirstName: KEVIN
AuthorizedOfficialMiddleName: G.
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 7344327581
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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