Individual
DEREK GEORGE DESOUZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20206 FARMINGTON RD, LIVONIA, MI 48152-1412
(248) 476-4724
(248) 476-7091
Mailing address
20206 FARMINGTON RD, LIVONIA, MI 48152-1412
(248) 476-4724
(248) 476-7091
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301042922
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1108211162
MEDICARE
MI
Enumeration date
08/18/2005
Last updated
12/24/2007
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