JOEL DINVERNO MD PC NPI 1053674184

NPI Information

  • NPI: 1053674184
  • Provider Name: JOEL DINVERNO MD PC
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • Doing Business As: SACRED HEART PEDIATRICS
  • CLIA Number: 23D1037775
  • Address: 11755 E MICHIGAN AVE
    GRASS LAKE, MI
    ZIP 49240
  • Phone: (517) 522-6100

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NPI Details

JOEL DINVERNO MD PC is a pediatrics in Grass Lake, MI. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. JOEL DINVERNO MD PC NPI is 1053674184. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Sacred Heart Pediatrics.

The provider's business location address is:

11755 E MICHIGAN AVE
GRASS LAKE, MI
ZIP 49240-219
Phone: (517) 522-6100
Fax: (517) 522-4715

The provider's authorized official is Joel Dinverno .
The authorized official title is Owner and has the following contact phone number (517) 522-6100.

The CLIA number assigned to this NPI record is 23D1037775 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/22/2012 and was last updated on 6/22/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatrics4301073676MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1G73511MEDICARE UPINMICHIGAN
23503810581OTHERMICHIGANBCBS
3104717265MEDICAIDMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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