Individual
DR. DAVID A DETRISAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3394 E JOLLY RD, STE A, LANSING, MI 48910-8595
(517) 394-3200
(517) 394-4250
Mailing address
3394 E JOLLY RD, STE A, LANSING, MI 48910-8595
(517) 394-3200
(517) 394-4250
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
4301044478
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0330079
BLUECARE NETWORK
MI
01
—
200000001107
PHYSICIANS HEALTH PLAN
MI
01
—
2003300791
BLUE CROSS/BLUE SHIELD
MI
05
—
4390460
—
MI
Enumeration date
06/27/2005
Last updated
12/13/2018
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