Individual
MICHAEL DETRISAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
812 AVIS DR, ANN ARBOR, MI 48108-9649
(734) 622-3920
Mailing address
PO BOX 104, NILES, MI 49120-0104
Taxonomy
Speciality
Code
Description
License number
State
2472E0500X
EEG Technician
Primary
—
—
Other
Enumeration date
12/07/2011
Last updated
12/07/2011
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