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Organization

LISA A MANZ DULAC MD & ASSOCIATES PC

Active
Other names
Eastside Dermatology PC
Organization subpart
No

Provider details

NPI number
Authorized official
LISA A MANZ-DULAC MD (OWNER)
(313) 884-3380
Entity
Organization

Contact information

Practice address
20030 MACK AVE, GROSSE POINTE WOODS, MI 48236-2323
(313) 884-3380
(313) 884-9756
Mailing address
20030 MACK AVE, GROSSE POINTE WOODS, MI 48236-2323
(313) 884-3380
(313) 884-9756

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
070H24887
BCBS OF MI GROUP NUMBER
MI
01
23D0916007
CLIA NUMBER
MI
Enumeration date
03/22/2006
Last updated
01/03/2012
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