Organization Name: | KEIRA DUVERNOY, DO, PC |
NPI Number: | 1699070870 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KEIRA DUVERNOY (PRESIDENT) |
Mailing Address: | 697 Hannah Ave Suite D Traverse City |
State: | MI US |
Postal Code: | 496862201 |
Phone Number: | 2319470900 |
Fax Number: | |
NPI Enumeration Date: | 01/19/2011 |
NPI Last Update Date: | 01/27/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 5101009710 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |