Provider Demographics
NPI:1427487214
Name:DELISLE, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DELISLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:MI
Mailing Address - Zip Code:48612-0576
Mailing Address - Country:US
Mailing Address - Phone:989-689-0069
Mailing Address - Fax:989-246-0820
Practice Address - Street 1:5356 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:MI
Practice Address - Zip Code:48628-9784
Practice Address - Country:US
Practice Address - Phone:989-689-0069
Practice Address - Fax:989-246-0820
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor