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Organization
PAUL V DETRISAC MD PC
Active
Organization
PAUL V DETRISAC MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL V DETRISAC (PRESIDENT)
(269) 684-8356
Entity
Organization
Contact information
Practice address
24 N SAINT JOSEPH AVE, NILES, MI 49120-2263
(269) 684-8356
Mailing address
PO BOX 998, NILES, MI 49120-0998
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
07/12/2007
Last updated
07/12/2007
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