Individual
DEEPA S MACHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 788-4996
(517) 796-6410
Mailing address
PO BOX 67000, DEPARTMENT 272801, DETROIT, MI 48267-0002
(517) 841-6913
(517) 841-6917
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301091124
MI
207P00000X
Emergency Medicine Physician
MD059163L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01592292
—
PA
Enumeration date
08/15/2005
Last updated
01/23/2008
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