Provider Demographics
NPI:1033473632
Name:DERRA, BRITTANY (DO)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:DERRA
Suffix:
Gender:F
Credentials:DO
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1701 SOUTH BOULEVARD E
Mailing Address - Street 2:SUITE 290
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6116
Mailing Address - Country:US
Mailing Address - Phone:734-464-0887
Mailing Address - Fax:734-402-0254
Practice Address - Street 1:1701 SOUTH BOULEVARD E
Practice Address - Street 2:SUITE 290
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6116
Practice Address - Country:US
Practice Address - Phone:734-464-0887
Practice Address - Fax:734-402-0254
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2022-07-12
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019947207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine