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DERYCK A KORHONEN PA-C

>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1538178058

Individual Registrant:
 DERYCK A KORHONEN PA-C
Gender: M
Not Sole Proprietor

Location and contact information for practice:
N15995 MAIN ST  POWERS, MI 49874-9608 US
Tel: 906-497-4360  Fax: 906-497-4362

Contact information for business:
N15995 MAIN ST  POWERS, MI 49874-9608 US
Tel: 906-497-4360  Fax: 906-497-4362

Registration Information:
NPI: 1538178058
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
MI5601003474

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
RR MEDICARE GROUP#CC2139970016972MI01




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