Provider Demographics
NPI:1457331704
Name:ORTEGA, JESUS (MD,)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJO4301031455207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1457331704OtherMEDICARE INDIVIDUAL NPI
MI110822641-1OtherBCBS OF MICHIGAN
MI1130860001OtherWELLNESS PLAN
MI0822641OtherBLUE CARE NETWORK
MIP00124985OtherRAILROAD MEDICARE
MIS19233OtherOAKWOOD MANAGED CARE
MIA76849Medicare UPIN
MI0P02000Medicare PIN
MIP02000001Medicare PIN