Organization
EAST LANSING ORTHOPEDIC ASSOCIATION P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID A DETRISAC MD (PRESIDENT)
(517) 394-3200
Entity
Organization
Contact information
Practice address
3394 E JOLLY RD, STE A, LANSING, MI 48910-8595
(517) 394-3200
(517) 394-4250
Mailing address
3394 E JOLLY RD, STE A, LANSING, MI 48910-8595
(517) 394-3200
(517) 394-4250
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-0C3-1063-0
GROUP BC/BS
MI
01
—
G04755
GROUP BCN
MI
Enumeration date
06/27/2005
Last updated
12/13/2018
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