Individual
DR. DERRICK MIKEL OUTLAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2882 DETROIT RD, NILES, MI 49120-9412
(574) 333-8775
Mailing address
2882 DETROIT RD, NILES, MI 49120-9412
(574) 333-8775
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
5501018789
MI
Other
Enumeration date
01/18/2019
Last updated
09/08/2021
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