Provider Demographics
NPI:1487196952
Name:DERAAD, MICHAEL (CFNP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DERAAD
Suffix:
Gender:M
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40463 S GROESBECK HWY
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-5005
Mailing Address - Country:US
Mailing Address - Phone:586-300-9114
Mailing Address - Fax:586-300-9115
Practice Address - Street 1:40463 S GROESBECK HWY
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-5005
Practice Address - Country:US
Practice Address - Phone:586-300-9114
Practice Address - Fax:586-300-9115
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704285839363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner