Provider Demographics
NPI:1851386254
Name:INOCENCIO, NORMA (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMA
Middle Name:
Last Name:INOCENCIO
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 1:2055 E 14 MILE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-7256
Mailing Address - Country:US
Mailing Address - Phone:248-645-1740
Mailing Address - Fax:248-645-5304
Practice Address - Street 1:2055 E 14 MILE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-7256
Practice Address - Country:US
Practice Address - Phone:248-645-1740
Practice Address - Fax:248-645-5304
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINI040049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114133OtherCARE CHOICES
MI148135OtherGLHP
MI4694705Medicaid
MI350F314450OtherBCBS OF MICHIGAN