Individual
KRISTIN DICELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
47601 GRAND RIVER AVE, SUITE C202, NOVI, MI 48374-1233
(248) 465-5955
Mailing address
1120 EDISON BLVD, PORT HURON, MI 48060-2030
(734) 255-2450
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601008080
MI
Other
Enumeration date
01/26/2017
Last updated
01/26/2017
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