Provider Demographics
NPI:1548234180
Name:DUVERNOY, KEIRA (DO)
Entity type:Individual
Prefix:
First Name:KEIRA
Middle Name:
Last Name:DUVERNOY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 HANNAH
Mailing Address - Street 2:STE A CENTER FOR INTEGRATIVE MEDICINE PC
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686
Mailing Address - Country:US
Mailing Address - Phone:231-947-0900
Mailing Address - Fax:231-947-9273
Practice Address - Street 1:697 HANNAH
Practice Address - Street 2:STE A CENTER FOR INTEGRATIVE MEDICINE PC
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686
Practice Address - Country:US
Practice Address - Phone:231-947-0900
Practice Address - Fax:231-947-9273
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010097102081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101009710OtherLICENSE
E26232Medicare UPIN
5280036Medicare ID - Type Unspecified