Provider Demographics
NPI:1730363441
Name:DEFLON, CASSIUS (MD)
Entity type:Individual
Prefix:
First Name:CASSIUS
Middle Name:
Last Name:DEFLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 S TELEGRAPH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0177
Mailing Address - Country:US
Mailing Address - Phone:248-451-9085
Mailing Address - Fax:248-451-9089
Practice Address - Street 1:1750 S TELEGRAPH RD STE 101
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0177
Practice Address - Country:US
Practice Address - Phone:248-451-9085
Practice Address - Fax:248-451-9089
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010285582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101783196Medicaid
MI0636373Medicare PIN
MI101783196Medicaid
MI0P57150Medicare PIN