Provider Demographics
NPI:1992010300
Name:ESTRADA, CESAR ELAGO JR
Entity Type:Individual
Prefix:MR
First Name:CESAR
Middle Name:ELAGO
Last Name:ESTRADA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 OGDEN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5392
Mailing Address - Country:US
Mailing Address - Phone:248-689-2502
Mailing Address - Fax:248-729-7225
Practice Address - Street 1:1421 OGDEN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5392
Practice Address - Country:US
Practice Address - Phone:248-689-2502
Practice Address - Fax:248-729-7225
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist