Michael Detrisac

Primary specialty

EEG TechnicianTaxonomy code 2472E0500X

Practice address

812 Avis Dr
Ann Arbor, MI 48108-9649

Phone

(734) 622-3920

NPI assigned

Dec 7, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323216000000",
    "number": "1053689836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 104",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491200104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 AVIS DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481089649",
            "telephone_number": "734-622-3920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETRISAC",
        "first_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-12-07",
        "last_updated": "2011-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2472E0500X",
            "taxonomy_group": "",
            "desc": "Technician, Other, EEG",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Masini Desmond, MD
• Kerri Rene Desomma
• Paul Desomma
• Deborah Ann Desrosiers, DDS
• Toni Dester, LMSW
• Matthew James Detrow, PHARM. D.
• Kirk Austin Dettloff, MD
• Kristen E Detweiler Short, NP
• Joshua Allen Deuel, D.D.S.
• Suhas Devangam, MD

• Other Technician in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Other Technician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.