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Contact Information

MICHAEL DETRISAC
812 AVIS DR
ANN ARBOR, MI48108-9649
 Phone: 734-622-3920
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

EEG

2472E0500X 75 Slide Preparation Facility
Indicates primary specialty

NPI Profile & details for MICHAEL DETRISAC · (Male)

NPI # 1053689836
Status Active
Credentials
Entity Individual
Enumeration date 12/07/2011
Last updated 12/07/2011 - About 15 years ago
Sole proprietor 1 Yes
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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