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Deactivated NPI 1124043674 Deactivated / Inactive NPI Male Practitioner

Dr. Archibald Winfred Dettman , DO

General Practice • Corunna, MI

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Archibald Dettman has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 13, 2006
NPI Deactivation Date June 07, 2023
Total Practice Duration ~17 Years of Practice (2006 – 2023)

Professional Overview & Biography Verified Profile Summary

Dr. Archibald Dettman, DO was a registered General Practice practicing in Corunna, MI. Throughout an active medical career spanning 17 years, Dr. Dettman provided care at the practice location at 115 N SHIAWASSEE ST until profile deactivation on 2023-06-07.

Practice Location & Contact Primary Location

Practice Address

115 N Shiawassee St

Corunna, MI 488171435

Telephone 9897433415
Fax 9897436180
Associated Practice Facility / Clinic
🏢 Archibald W. Dettman Facility NPI 1184642886

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Corunna, MI

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 29.4 Yrs
Regional Practice Density
1 Specialists

Practicing in Corunna, MI (445 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License MI 5101006898

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

6 Associated Practitioners
Dr. Wanda Iza , MD

Family Medicine

NPI 1033147699

Doctor of Medicine (M.D.)

Kadee Fortino , PA-C

Physician Assistant

NPI 1215700398

Physician Assistant (Certified)

Dr. Maryam Somo , MD

Family Medicine

NPI 1437644127

Doctor of Medicine (M.D.)

Lauren Esper , FNP

Nurse Practitioner - Family

NPI 1578319109

Family Nurse Practitioner

NPI 1639630742

Doctor of Medicine (M.D.)

Diana Hayes , CFNP

Nurse Practitioner - Family

NPI 1760594881

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated June 07, 2023

Record deactivated on June 07, 2023

NPI Profile Active June 25, 2008

NPI status registered as active in NPPES database

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Updated Practice Location June 25, 2008

Registered at 115 N SHIAWASSEE ST, CORUNNA, MI 488171435 (Tel: 9897433415)

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Updated Business Mailing Address June 25, 2008

Registered at 115 N SHIAWASSEE ST, CORUNNA, MI 488171435 (Tel: 9897433415)

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Provider Name / Credentials Updated June 25, 2008

Recorded as ARCHIBALD DETTMAN, D.O.

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Medical Taxonomy / Specialty Registered (Primary Specialty) June 25, 2008

General Practice (License #5101006898 in MI)

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Initial NPI Registration & Enumeration July 13, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1124043674
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 13, 2006
Last Update: June 25, 2008
Deactivation Date: June 07, 2023

Mailing Address

115 N Shiawassee St

Corunna, MI 488171435

Phone: 9897433415

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.