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Individual

ISAAC DEATHERAGE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DO, MPH

Contact information

Practice address
18627 144TH AVE, SPRING LAKE, MI 49456-9520
(918) 814-6422
Mailing address
18627 144TH AVE, SPRING LAKE, MI 49456-9520
(918) 814-6422

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
5101028511
MI

Other

Enumeration date
04/27/2023
Last updated
04/09/2025
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