Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Paul V Detrisac MD PC

Organization Internal Medicine Physician · NPI 1629277439

Paul V Detrisac MD PC is an Internal Medicine Physician in Niles, Michigan. Registered with an NPI since 2007.

In the registry since
2007
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

24 N Saint Joseph Ave
Niles, MI 49120-2263
Phone: (269) 684-8356
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X

Record details

NPI number1629277439
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Paul Detrisac — President · (269) 684-8356
NPI enumeratedJuly 12, 2007
Last updated in NPPESJuly 12, 2007
Mailing addressPo Box 998, Niles, MI 49120-0998

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