Provider Demographics
NPI:1518236199
Name:ERNESTO S. DUTERTE MD PC
Entity Type:Organization
Organization Name:ERNESTO S. DUTERTE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:S
Authorized Official - Last Name:DUTERTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-732-7460
Mailing Address - Street 1:1119 VILLA LINDE CT STE 37
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3410
Mailing Address - Country:US
Mailing Address - Phone:810-732-7460
Mailing Address - Fax:810-732-0466
Practice Address - Street 1:1119 VILLA LINDE CT STE 37
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3410
Practice Address - Country:US
Practice Address - Phone:810-732-7460
Practice Address - Fax:810-732-0466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIED036113385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA76318Medicare UPIN