Individual
MR. DEREK STORCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
42348 MALBECK DR, STERLING HEIGHTS, MI 48314-3043
(618) 910-0465
Mailing address
929 STACEY BURK DR, FLORA, IL 62839-3241
(618) 910-0465
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
4704322025
MI
363LP2300X
Primary Care Nurse Practitioner
Primary
209016175
IL
Other
Enumeration date
01/27/2017
Last updated
11/27/2019
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