Provider Demographics
NPI:1033313473
Name:ADELINA W HERRERO MD PC
Entity Type:Organization
Organization Name:ADELINA W HERRERO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ADELINA
Authorized Official - Middle Name:W
Authorized Official - Last Name:HERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-246-8282
Mailing Address - Street 1:316 ECORSE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5732
Mailing Address - Country:US
Mailing Address - Phone:734-246-8282
Mailing Address - Fax:734-246-5714
Practice Address - Street 1:316 ECORSE RD STE 100
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5732
Practice Address - Country:US
Practice Address - Phone:734-246-8282
Practice Address - Fax:734-246-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032776207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301032776OtherLICENSE
MI0608116702OtherBLUE CROSS
MI1052173Medicaid
MI4301032776OtherLICENSE
MI0811670Medicare ID - Type Unspecified