Provider Demographics
NPI:1467405605
Name:CADENA, ESMERELDA (MD)
Entity Type:Individual
Prefix:
First Name:ESMERELDA
Middle Name:
Last Name:CADENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 STATE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4328
Mailing Address - Country:US
Mailing Address - Phone:616-685-1808
Mailing Address - Fax:616-685-1850
Practice Address - Street 1:245 CHERRY ST SE
Practice Address - Street 2:SUITE 306
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4607
Practice Address - Country:US
Practice Address - Phone:616-685-8512
Practice Address - Fax:616-336-9952
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078795208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4327439Medicaid
MI4617840Medicaid
MI4877518Medicaid
MI4878121Medicaid
MI4877518Medicaid
MIM69390194Medicare ID - Type Unspecified