Provider Demographics
NPI:1154502243
Name:JESUS ORTEGA, M.D., P.L.L.C.
Entity Type:Organization
Organization Name:JESUS ORTEGA, M.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-381-5522
Mailing Address - Street 1:6760 ALLEN RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2078
Mailing Address - Country:US
Mailing Address - Phone:313-381-5522
Mailing Address - Fax:313-381-2666
Practice Address - Street 1:6760 ALLEN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2078
Practice Address - Country:US
Practice Address - Phone:313-381-5522
Practice Address - Fax:313-381-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJO4301031455207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1130860001OtherWELLNESS PLAN
MI1457331704OtherINDIVIDUAL NPI
MI110822641-1OtherBCBS OF MICHIGAN
MIP00124985OtherRAILROAD MEDICARE
MIS19233OtherOAKWOOD MANAGED CARE
MI0822641OtherBLUE CARE NETWORK
MI110822641-1OtherBCBS OF MICHIGAN
MIA76849Medicare UPIN
MIS19233OtherOAKWOOD MANAGED CARE