Paul V Detrisac MD PC
Paul V Detrisac MD PC is a healthcare organization registered as Internal Medicine Physician in Niles, MI, holding Type 2 (organization) NPI 1629277439 since 2007. The authorized official on file is Paul Detrisac, President.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1629277439 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Paul V Detrisac MD PC |
| Practice address | 24 N SAINT JOSEPH AVE, Niles, MI, 49120 |
| Phone | 2696848356 |
| Enumeration date | 2007-07-12 |
| Last updated in NPPES | 2007-07-12 |
Authorized official
| Name | Paul Detrisac |
|---|---|
| Title | President |
| Phone | 2696848356 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 207R00000X | Internal Medicine Physician | Primary | — | — |
Copy-ready billing details
Provider: Paul V Detrisac MD PC NPI: 1629277439 Taxonomy: 207R00000X (Internal Medicine Physician) Address: 24 N SAINT JOSEPH AVE, Niles, MI, 49120
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1952336653 | Florentino Aquino | Individual | Surgery Physician | Niles, MI |
| 1023145703 | Douglas Tacket Do Pllc | Organization | Family Medicine Physician | Niles, MI |
| 1992826366 | Tracy J Tacket Do Pllc | Organization | Family Medicine Physician | Niles, MI |
| 1225256712 | Joe Francisco | Individual | Clinical Social Worker | Niles, MI |
| 1609063551 | West Michigan Hearing Specialists LLC | Organization | Audiologist-Hearing Aid Fitter | Niles, MI |
| 1285805879 | Cardiovascular Diseases of Niles, P.C. | Organization | Cardiovascular Disease Physician | Niles, MI |
| 1588964415 | Michelle Ridenour | Individual | Audiologist-Hearing Aid Fitter | Niles, MI |
| 1164862181 | Michael Flewelling | Individual | General Practice Dentistry | Niles, MI |
Verify this record
Cross-check NPI 1629277439 against the authoritative CMS record: view Paul V Detrisac MD PC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What type of organization is Paul V Detrisac MD PC?
What is a Type 2 NPI?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2007-07-12.