David A Detrisac, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

4301044478 Issued in MI

Practice address

3394 E Jolly Rd
Ste a
Lansing, MI 48910-8595

Phone

(517) 394-3200

Fax

(517) 394-4250

NPI assigned

Jun 27, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544659200000",
    "number": "1730185539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3394 E JOLLY RD",
            "address_2": "STE A",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489108595",
            "telephone_number": "517-394-3200",
            "fax_number": "517-394-4250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3394 E JOLLY RD",
            "address_2": "STE A",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489108595",
            "telephone_number": "517-394-3200",
            "fax_number": "517-394-4250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETRISAC",
        "first_name": "DAVID",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-27",
        "last_updated": "2018-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": "4301044478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIANS HEALTH PLAN",
            "identifier": "200000001107",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "2003300791",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECARE NETWORK",
            "identifier": "0330079",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4390460",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Garrett Descoteaux-Friday, D.O.
• Laurie Danielle Desilva
• Abigail Desmyter, PA-C
• Heather Kirsten Desroberts, OTR/L
• Sara Ann Detlor, MSPT
• Karla Dettling
• Joanne Dettro
• Tyler Scott Dettro, MD
• Melissa M Devine
• Rahul Devkota, MD

• All providers in Lansing, MI
• Orthopaedic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2018; 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.