Geoffrey R Detolve, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301064382 Issued in MI

Practice address

601 John St
Suite E352
Kalamazoo, MI 49007-5341

Phone

(269) 341-8986

Fax

(269) 341-6236

NPI assigned

Jan 19, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416182400000",
    "number": "1184604795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 JOHN ST",
            "address_2": "SUITE E352",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075341",
            "telephone_number": "269-341-8986",
            "fax_number": "269-341-6236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 JOHN ST",
            "address_2": "SUITE E352",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075341",
            "telephone_number": "269-341-8986",
            "fax_number": "269-341-6236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETOLVE",
        "first_name": "GEOFFREY",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2014-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301064382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184604795",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4385657",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM - BMH TAX ID# 38-1359087",
            "identifier": "1417961137",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Star Deshane
• Cynthia M Deskovitz
• Christopher D Despain
• Destiny Wellness & Consulting PLLC
• Renee Ruth Desvoignes, CMT
• Evan Mark Deutsch, M.D.
• Brian Robert Devetter, MD
• Andrea Devries
• Carolyn Monique Devries, OTR/L
• Joy Devries

• Pediatrics Physician in Kalamazoo, MI
• Providers in Kalamazoo, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.