Provider Demographics
NPI:1114044666
Name:INEZ, NARCISO O (MD)
Entity Type:Individual
Prefix:DR
First Name:NARCISO
Middle Name:O
Last Name:INEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 CHEVY CIRCUIT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-3905
Mailing Address - Country:US
Mailing Address - Phone:248-601-1103
Mailing Address - Fax:248-601-9776
Practice Address - Street 1:1451 CHEVY CIRCUIT
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48306-3905
Practice Address - Country:US
Practice Address - Phone:248-601-1103
Practice Address - Fax:248-601-9776
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032013208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0206362731OtherBCBSMI
MI624920Medicaid
MIB43575Medicare UPIN
MI0206362731OtherBCBSMI