Individual
GEOFFREY R DETOLVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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