Individual
ANDREW JOSEPH DETTORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
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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