Provider Demographics
NPI:1043236490
Name:DERRO, NORMA CLEMENTE (MD)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:CLEMENTE
Last Name:DERRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:29818 COTTONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1922
Mailing Address - Country:US
Mailing Address - Phone:248-788-1936
Mailing Address - Fax:
Practice Address - Street 1:30901 PALMER RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-9529
Practice Address - Country:US
Practice Address - Phone:734-367-8403
Practice Address - Fax:734-722-9524
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301037231207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1508883299OtherWRPH
MINC037231OtherLICENSE
MI4870796OtherMEDICAID
MI010Q26258OtherBCBSM GR#
MI1508883299OtherWRPH
MI234035Medicare Oscar/Certification