Provider Demographics
NPI:1801839899
Name:DRELICHMAN, ERNESTO R (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:R
Last Name:DRELICHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16001 W 9 MILE RD
Mailing Address - Street 2:3RD FLOOR FISHER
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4818
Mailing Address - Country:US
Mailing Address - Phone:248-849-6030
Mailing Address - Fax:
Practice Address - Street 1:16001 W 9 MILE RD
Practice Address - Street 2:3RD FLOOR FISHER
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4818
Practice Address - Country:US
Practice Address - Phone:248-849-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26148208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00153440OtherRAILROAD MEDICARE
AL009968565Medicaid
MI020F364690OtherBCBSM
AL009964605Medicaid
AL051524168OtherBLUE CROSS
AL051524172OtherBLUE CROSS
MI1801839899Medicaid
MI020F364690OtherBCBSM
AL009968565Medicaid