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Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

PAUL V DETRISAC, MD

Active

PAUL V DETRISAC, MD is a Critical Care Medicine healthcare provider located in NILES, Michigan. NPI 1962506527 is currently active in the NPPES registry. Verify at CMS.

Critical Care Medicine · NILES, MI

Registration Details

NPI Number
1962506527
Provider Type
Individual
Gender
Male
NPI Issued
Sep 12, 2006 (19.946512311693 yrs)
Last Updated
Jul 10, 2007
Licenses
PD043661 (MI)
01032411A (IN)

Practice Information

Address
24 N ST JOSEPH AVE
NILES, MI, 49120
Browse MI providers · Browse ZIP 49120
Phone
2696848356
Primary Specialty
Critical Care Medicine
207RC0200X
Additional Specialty
Critical Care Medicine
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.