Basic Information
Provider Information
NPI: 1669826806
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOYE
FirstName: DIAVET
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3048 CARTER ST
Address2:  
City: DETROIT
State: MI
PostalCode: 482064102
CountryCode: US
TelephoneNumber: 3135492469
FaxNumber:  
Practice Location
Address1: 2925 RUSSELL ST
Address2:  
City: DETROIT
State: MI
PostalCode: 482074825
CountryCode: US
TelephoneNumber: 3132743700
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/13/2016
LastUpdateDate: 04/13/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
172V00000X6802077931MIY Other Service ProvidersCommunity Health Worker 

No ID Information.


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