Andrew Joseph Dettore, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

5101014925 Issued in MI

Practice address

23050 West Rd
Ste. 110
Brownstown TWP, MI 48183-1472

Phone

(734) 671-9800

Fax

(734) 671-7690

NPI assigned

May 22, 2007

Last updated

Feb 27, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: adettore56811@direct.hfhs.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Downriver Pediatric Associates P.C.

  • Pediatrics Physician
  • Brownstown TWP, MI
  • NPI 1124137534
  NPD (past)

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393459200000",
    "number": "1649489808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23125 WAGONWHEEL DR",
            "city": "BROWNSTOWN TWP",
            "state": "MI",
            "postal_code": "481831160",
            "telephone_number": "248-981-5769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23050 WEST RD",
            "address_2": "STE. 110",
            "city": "BROWNSTOWN TWP",
            "state": "MI",
            "postal_code": "481831472",
            "telephone_number": "734-671-9800",
            "fax_number": "734-671-7690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTORE",
        "first_name": "ANDREW",
        "middle_name": "JOSEPH",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2014-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5101014925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Crossley
• Crossover Health Medical Group (Crossover @ Brownstown)
• Custom Fit Physical Therapy PLLC (Custom Fit Physical Therapy)
• Wael Hussein Dabaja, D.O.
• Kenneth Jerome Dennis
• Jignesh Dhananjay Dhrangadharia, P.T
• Discount Drugs LLC (Discount Drugs)
• Downriver Cancer Center (Josephine Ford Cancer Center)
• Downriver Operations, LLC (Elmcroft of Downriver)
• Downriver Pediatric Associates P.C.

• Pediatrics Physician in Brownstown TWP, MI
• Providers in Brownstown TWP, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 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.