Individual
GEOFFREY R DETOLVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
601 JOHN ST, SUITE E352, KALAMAZOO, MI 49007-5341
(269) 341-8986
(269) 341-6236
Mailing address
601 JOHN ST, SUITE E352, KALAMAZOO, MI 49007-5341
(269) 341-8986
(269) 341-6236
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301064382
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184604795
—
MI
01
—
1417961137
BCBSM - BMH TAX ID# 38-1359087
MI
05
—
4385657
—
MI
Enumeration date
01/19/2006
Last updated
11/17/2014
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