Provider Demographics
NPI:1467533455
Name:FLORES-LAJA, THELMA (MD)
Entity Type:Individual
Prefix:DR
First Name:THELMA
Middle Name:
Last Name:FLORES-LAJA
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 1:19141 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-6007
Mailing Address - Country:US
Mailing Address - Phone:313-835-8500
Mailing Address - Fax:313-835-3081
Practice Address - Street 1:19141 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-6007
Practice Address - Country:US
Practice Address - Phone:313-835-8500
Practice Address - Fax:313-835-3081
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2010-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047471207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
021934OtherMIDWEST HEALTH PLAN
129455OtherCARE CHOICES
MI912188529OtherBCBCSM
MI104490616Medicaid
A79394Medicare UPIN
0N68140003Medicare ID - Type Unspecified