Male or Other

Brian R. Derderian

Technician/Technologist in Shelby Township, MI(View on Map)

Full Name

Brian Robert Derderian

NPI Number

1356090021

NPI Type

Individual Provider

Gender

Male

Enumeration Date

03/21/2022

Specialties

(Taxonomies)

Code

156F00000X

Primary Taxonomy

Yes

Contact
Information

Purpose

Mailing
Location

Address

49970 VAN DYKE AVE
49970 VAN DYKE AVE

City

Shelby Township
Shelby Township

State

MI
MI

Postal Code

48317-1347
48317-1347

Country

US
US

Telephone Number

(586) 991-6596
(586) 991-6596

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 03/21/2022

Provider Address

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