Divi MD PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301062122 Issued in MI

Legal business name

DIVI MD PC

Practice address

20755 Greenfield Rd
Ste #1004
Southfield, MI 48075-5403

Phone

(248) 424-5090

Fax

(248) 424-5091

NPI assigned

Jul 26, 2006

Last updated

Dec 14, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Thulasi S Divi, MDNPI 1720021900

Title

Owner/President

Phone

(248) 528-1555

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Thulasi S Divi, MD

  • Family Medicine Physician
  • Southfield, MI
  • NPI 1720021900
  Authorized official Same address or phone

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260748800000",
    "number": "1972527026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20755 GREENFIELD ROAD",
            "address_2": "STE # 1004",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480755411",
            "telephone_number": "248-424-5090",
            "fax_number": "248-424-5091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20755 GREENFIELD RD",
            "address_2": "STE #1004",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480755403",
            "telephone_number": "248-424-5090",
            "fax_number": "248-424-5091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVI MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2009-12-14",
        "status": "A",
        "authorized_official_last_name": "DIVI",
        "authorized_official_first_name": "THULASI",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "248-528-1555",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301062122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA CERTIFICATE",
            "identifier": "23D0988999",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4226454",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas J Ditkoff, MD
• Brandy Divelly
• Diversified Alternative Living, LLC
• Diversified Health Care Management Consultants, Inc (Little Tots & Moms)
• Diversified Home Health Care Inc
• Thulasi S Divi, MD
• Divine Expressions Homecare LLC
• Divine Home & Health Support LLC
• Divine Home Care of Michigan
• Divine Homecare Agency LLC

• Family Medicine Physician in Southfield, MI
• Providers in Southfield, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2009; 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.