Provider Demographics
NPI:1033189576
Name:DROUILLARD, PAUL J (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:DROUILLARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6255 INKSTER RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2577
Mailing Address - Country:US
Mailing Address - Phone:734-422-8400
Mailing Address - Fax:734-422-6273
Practice Address - Street 1:6255 INKSTER RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135
Practice Address - Country:US
Practice Address - Phone:734-422-8400
Practice Address - Fax:734-422-6273
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2018-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008177207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2752040Medicaid
MI5823029OtherBCBSM
MI5823029OtherBCBSM
MIE49718Medicare UPIN