Individual
AMY DERECZYK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4001 W MCNICHOLS RD, DETROIT, MI 48221-3038
(313) 993-1797
(313) 993-1271
Mailing address
4001 W MCNICHOLS RD, DETROIT, MI 48221-3038
(313) 993-1797
(313) 993-1271
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003980
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11712511
CAQH
—
Enumeration date
01/04/2006
Last updated
05/10/2011
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