| NPI | 1104865633 |
|---|---|
| NPI Type | NPI-1 Individual |
| Status | Active |
| Enumeration Date | 2006-06-06 |
| Last Updated | 2009-01-26 |
| Mailing Address | 11755 E Michigan Ave Grass Lake, MI 49240-9219 United States Phone: (517) 522-6100 | Fax: (517) 522-4715 📍 View Map |
| Primary Practice Address | 11755 E Michigan Ave Grass Lake, MI 49240-9219 United States Phone: (517) 522-6100 | Fax: (517) 522-4715 📍 View Map |
| Issuer | State | Number | Other Issuer |
|---|---|---|---|
| MEDICAID | MI | 104717265 | — |
| Other (non-Medicare) | MI | 3503810581 | BCBS |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| Yes | 208000000X – Pediatrics | MI | 4301073676 |
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About NPI 1104865633
Joel Benjamin Dinverno MD is a healthcare provider registered in the CMS NPPES NPI Registry with NPI number 1104865633. The primary specialty listed is Pediatrics. The provider is located in Grass Lake, MI. This NPI is classified as a Type 1 (Individual) NPI and is currently active. The NPI was first enumerated (assigned) on 2006-06-06. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1104865633?
NPI 1104865633 belongs to Joel Benjamin Dinverno MD, a Pediatrics in Grass Lake, MI. It is a Type 1 Individual NPI registered in the CMS NPPES NPI Registry.
Is NPI 1104865633 active?
The current status of NPI 1104865633 in the NPPES registry is Active. The record was last updated on 2009-01-26.
What specialty is NPI 1104865633?
NPI 1104865633 is classified under the taxonomy Pediatrics. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1104865633?
You can verify NPI 1104865633 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1104865633?
The primary practice address on file for NPI 1104865633 is 11755 E Michigan Ave, Grass Lake, MI 49240-9219. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1104865633 issued?
NPI 1104865633 was first issued (enumerated) on 2006-06-06. The NPPES record was last updated on 2009-01-26.
Practice Location Map
Joel Benjamin Dinverno is located at 11755 E Michigan Ave, Grass Lake, MI. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as Joel Benjamin Dinverno. All records sourced from the CMS NPPES registry.
License Information
The following state license numbers are on file in the NPPES registry for NPI 1104865633. For license status verification, contact the relevant state licensing board directly.
| Specialty / Taxonomy | License Number | State |
|---|---|---|
| Pediatrics | 4301073676 | MI |