Provider Demographics
NPI:1407844251
Name:PRUITT, DELICIA JANELLE (MD)
Entity Type:Individual
Prefix:
First Name:DELICIA
Middle Name:JANELLE
Last Name:PRUITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602
Mailing Address - Country:US
Mailing Address - Phone:989-746-7500
Mailing Address - Fax:989-583-6955
Practice Address - Street 1:1575 CONCENTRIC BLVD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9311
Practice Address - Country:US
Practice Address - Phone:989-746-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1012438OtherMCLAREN HEALTH PLAN
MI4686660OtherMOLINA HEALTH CARE
MIP33641FOtherBLUE CARE NETWORK
MI0997569OtherHEALTHPLUS
MI296OtherCOMMUNITY CHOICE
381908328OtherTRICARE
381908328OtherHCAP
MI080G310660OtherBCBS
142119OtherGREAT LAKES HEALTH PLAN
381908328OtherFIRST HEALTH
MI4686660Medicaid
7484518OtherAETNA
381908328OtherPPOM
MI4686660OtherMOLINA HEALTH CARE
1012438OtherMCLAREN HEALTH PLAN
MI296OtherCOMMUNITY CHOICE