Provider Demographics
NPI:1851657365
Name:ADELINA W HERRERO MD PLLC
Entity Type:Organization
Organization Name:ADELINA W HERRERO MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-483-9474
Mailing Address - Street 1:1159 E MICHIGAN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1159 E MICHIGAN AVE STE E
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5807
Practice Address - Country:US
Practice Address - Phone:734-483-9474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032776208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty