Provider Demographics
NPI:1790399111
Name:PLITT, DEREK ANDREW
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:ANDREW
Last Name:PLITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 WILLIAMS ST # 2214
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-2563
Mailing Address - Country:US
Mailing Address - Phone:269-849-5375
Mailing Address - Fax:
Practice Address - Street 1:1325 WILLIAMS ST # 2214
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2563
Practice Address - Country:US
Practice Address - Phone:269-849-5375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer