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NPI Code Detail

MEDICARE: DESIRAE DYAN DELBRIDGE PA-C

MEDICARE: DESIRAE DYAN DELBRIDGE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant5601006127MI

General Provider Information

NPI Number : 1407138399
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESIRAE DYAN DELBRIDGE PA-C
Provider Business Mailing Address
First Line : 225 E 5TH ST
Second Line : SUITE 300
City : FLINT
State : MI
Zip : 48502-1641
Country : US
Telephone Number : 810-406-4246
Fax Number :
Provider Business Practice Location Address
First Line : 4154 W VIENNA RD
Second Line :
City : CLIO
State : MI
Zip : 48420-2809
Country : US
Telephone Number : 810-687-1008
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2011
Last Update Date : 06/05/2012

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