Individual
DORU LICA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4967 CROOKS RD, SUITE 130, TROY, MI 48098-5801
(248) 952-1601
Mailing address
641 PRINCESS DR, CANTON, MI 48188-1143
(734) 718-2878
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005163
MI
Other
Enumeration date
11/15/2007
Last updated
12/03/2013
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