Provider Demographics
NPI:1487868121
Name:FERRARER-BLAIR, HILDA C (MD)
Entity Type:Individual
Prefix:MRS
First Name:HILDA
Middle Name:C
Last Name:FERRARER-BLAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HILDA
Other - Middle Name:C
Other - Last Name:FERRARER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:80650 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:BRUCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48065-1333
Mailing Address - Country:US
Mailing Address - Phone:810-798-6410
Mailing Address - Fax:810-798-6419
Practice Address - Street 1:80650 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:BRUCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48065-1333
Practice Address - Country:US
Practice Address - Phone:810-798-6410
Practice Address - Fax:810-798-6419
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO046970207Q00000X
MI4301085592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO019285OtherKAISER COMMERCIAL NUMBER
CO97538841Medicaid