Provider Demographics
NPI:1164565974
Name:BILBAO, RAFAEL ERNESTO LEDESMA JR (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ERNESTO LEDESMA
Last Name:BILBAO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 JEFFERSON AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4502
Mailing Address - Country:US
Mailing Address - Phone:616-685-5576
Mailing Address - Fax:616-685-8910
Practice Address - Street 1:200 JEFFERSON AVE SE STE 626
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4502
Practice Address - Country:US
Practice Address - Phone:616-685-5576
Practice Address - Fax:616-685-8910
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301082270208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP32930348Medicare PIN