Individual
ANDREW JOSEPH DETTORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
23050 WEST RD, STE. 110, BROWNSTOWN TWP, MI 48183-1472
(734) 671-9800
(734) 671-7690
Mailing address
23125 WAGONWHEEL DR, BROWNSTOWN TWP, MI 48183-1160
(248) 981-5769
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
5101014925
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5199923
—
MI
01
—
5821561
BCBS
—
01
—
6U9940
HAP
—
Enumeration date
05/22/2007
Last updated
02/27/2014
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