Basic Information
Provider Information
NPI: 1851603880
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DILORETO
FirstName: EMILY
MiddleName: DENESGE
NamePrefix: MRS.
NameSuffix:  
Credential: MS, PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 26901 BEAUMONT BLVD STE 3D
Address2:  
City: SOUTHFIELD
State: MI
PostalCode: 480333849
CountryCode: US
TelephoneNumber: 9475221865
FaxNumber: 9475220307
Practice Location
Address1: 3601 W 13 MILE RD
Address2:  
City: ROYAL OAK
State: MI
PostalCode: 480736712
CountryCode: US
TelephoneNumber: 2488985000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/07/2010
LastUpdateDate: 07/15/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/15/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X5601005793MIY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

ID Information
IDTypeStateIssuerDescription
109253101 NCCPAOTHER
560100579301MIPHYSICIAN ASSISTANT LICENSE STATE OF MICHIGAN DEPARTMENT OF COMMUNITY HEALTHOTHER


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