Joel Benjamin Dinverno, MD
Individual provider Active NPI Pediatrics Physician · Grass Lake, MI
NPI 1104865633 · NPPES record last updated Jan 26, 2009
Key facts
- NPI
- 1104865633
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 4301073676 (MI)
- Practice address
- 11755 E Michigan Ave
Grass Lake, MI 49240-9219 - Phone
- (517) 522-6100
- Fax
- (517) 522-4715
- NPI assigned
- Jun 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Joel Dinverno MD PC | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- jdinverno462735@direct.hfhs.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4301073676 | MI | Yes |
Addresses
Primary practice location
11755 E Michigan Ave
Grass Lake, MI 49240-9219
Mailing address
11755 E Michigan Ave
Grass Lake, MI 49240-9219
Phone (517) 522-6100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3503810581 | Other | MI | BCBS |
| 104717265 | Medicaid | MI |
Other providers in Grass Lake, MI
- Commet Welcome Pharmacies Inc
- Compassionate Daughters Home Care LLC.
- Katherine A Cox
- Shana Crouch
- Jill Dean
- Patrick Raymond Eckes
- Deana Fisher
- David Oneill Foley
- Holly Elizabeth Gist-Richer
- Grass Lake Chiropractic Center, PLLC
All providers in Grass Lake, MI · Pediatrics Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.