Detrisac, David A

Detrisac, David A is an individual health care provider with primary practice located at 3394 E Jolly Rd Ste A, Lansing MI 48910-8595. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Detrisac, David A can be contacted via phone (517) 394-3200.

Contact Information

Primary practice address
3394 E Jolly Rd Ste A Lansing MI 48910-8595
Phone: (517) 394-3200
Fax: (517) 394-4250
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 4301044478 Michigan

Profile Details

NPI number 1730185539
LBN Legal business name Detrisac, David A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 27th, 2005
Last updated Dec 13th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730185539 NPPES
Michigan Other 200000001107 PHYSICIANS HEALTH PLAN
Michigan Other 2003300791 PHYSICIANS HEALTH PLAN
Michigan Other 0330079 PHYSICIANS HEALTH PLAN
Michigan MEDICAID 4390460 PHYSICIANS HEALTH PLAN

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