Dereczyk, Amy

Dereczyk, Amy is an individual health care provider with primary practice located at 4001 W Mcnichols Rd , Detroit MI 48221-3038. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Dereczyk, Amy can be contacted via phone (313) 993-1797.

Contact Information

Primary practice address
4001 W Mcnichols Rd Detroit MI 48221-3038
Phone: (313) 993-1797
Fax: (313) 993-1271
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 5601003980 Michigan

Profile Details

NPI number 1558349050
LBN Legal business name Dereczyk, Amy
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 4th, 2006
Last updated May 10th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558349050 NPPES
Other 11712511 CAQH

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