Individual
JILL F. DELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11900 E 12 MILE RD, SUITE 103, WARREN, MI 48093-3400
(586) 574-0890
(586) 574-9321
Mailing address
11900 E 12 MILE RD, SUITE 103, WARREN, MI 48093-3400
(586) 574-0890
(586) 574-9321
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005004
MI
363AM0700X
Medical Physician Assistant
5601005004
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601005004
STATE LICENSE
MI
Enumeration date
08/05/2007
Last updated
01/19/2016
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