Provider Demographics
NPI:1295997922
Name:INFINITY PRIMARY CARE, PLLC
Entity type:Organization
Organization Name:INFINITY PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:DEIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-432-7581
Mailing Address - Street 1:PO BOX 673135
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-3135
Mailing Address - Country:US
Mailing Address - Phone:734-464-8300
Mailing Address - Fax:734-464-8301
Practice Address - Street 1:1600 S CANTON CENTER RD
Practice Address - Street 2:SUITE 220
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1992
Practice Address - Country:US
Practice Address - Phone:734-398-8790
Practice Address - Fax:734-398-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N91620Medicare PIN