Healthcare Provider Details

I. General information

NPI: 1508661760
Provider Name (Legal Business Name): NICHOLAS DIROFF PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29877 TELEGRAPH RD STE 401
SOUTHFIELD MI
48034-7661
US

IV. Provider business mailing address

14728 OLD TOWN CT
RIVERVIEW MI
48193-7711
US

V. Phone/Fax

Practice location:
  • Phone: 248-651-8344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601012927
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: