Detrisac, Paul V
Detrisac, Paul V is an individual health care provider with primary practice located at 24 N St Joseph Ave , Niles MI 49120. He recently has only one registered license in Allopathic & Osteopathic Physicians / Critical Care Medicine, which is considered as his primary health care specialty. Detrisac, Paul V can be contacted via phone (269) 684-8356.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Critical Care Medicine | 207RC0200X | PD043661 | Michigan |
| Allopathic & Osteopathic Physicians / Critical Care Medicine | 207RC0200X | 01032411A | Indiana |
Profile Details
| NPI number | 1962506527 |
|---|---|
| LBN Legal business name | Detrisac, Paul V |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 12th, 2006 |
| Last updated | Jul 10th, 2007 - about 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1962506527 | NPPES |
| Michigan | MEDICAID | 1508904 |
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