Individual
DR. EDWARD JOHN DISTELHORST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 MELVIN AVE, SUITE 7A, ANNAPOLIS, MD 21401-1514
(410) 280-2260
Mailing address
255 W MICHIGAN AVE, JACKSON, MI 49201-2218
(517) 787-6440
(517) 787-4146
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
D0022107
MD
Other
Enumeration date
06/24/2006
Last updated
11/14/2007
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