Individual
DR. HAROLD S DERSTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6071 W OUTER DR, DETROIT, MI 48235-2624
(313) 966-3300
Mailing address
510 W 4TH ST, ROYAL OAK, MI 48067-2402
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301063998
MI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
4301063998
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103380191
—
MI
01
—
HD063998
BC/BS OF MI
MI
Enumeration date
03/27/2006
Last updated
06/18/2010
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