Provider Demographics
NPI:1992214928
Name:ESTRADA, GENENE MARGIT
Entity Type:Individual
Prefix:MISS
First Name:GENENE
Middle Name:MARGIT
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17515 W 9 MILE RD STE 375
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4404
Mailing Address - Country:US
Mailing Address - Phone:248-450-3942
Mailing Address - Fax:248-450-3946
Practice Address - Street 1:17515 W 9 MILE RD STE 375
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4404
Practice Address - Country:US
Practice Address - Phone:248-450-3942
Practice Address - Fax:248-450-3946
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty