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Organization
THEORIA MEDICAL
Active
Organization
THEORIA MEDICAL
Active
Other names
Justin P Direzze MD SOLE MBR
Organization subpart
No
Provider details
NPI number
Authorized official
SVETLANA VINOKUR (CFO)
(847) 275-9504
Entity
Organization
Contact information
Practice address
41800 W 11 MILE RD STE 109, NOVI, MI 48375-1818
(248) 860-4634
(248) 282-5044
Mailing address
41800 W 11 MILE RD STE 109, NOVI, MI 48375-1818
(248) 860-4634
(248) 282-5044
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2084P0800X
Psychiatry Physician
—
—
310400000X
Assisted Living Facility
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0411248
—
OH
Enumeration date
07/06/2018
Last updated
02/05/2026
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