Individual
IDRISSA DERRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3906 TURNBRIDGE CT UNIT 311, BRUNSWICK, OH 44212-3093
(216) 801-5639
Mailing address
3906 TURNBRIDGE CT UNIT 311, BRUNSWICK, OH 44212-3093
(216) 801-5639
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
05/08/2021
Last updated
11/28/2022
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