Individual
DR. DAVID A DETRISAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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