Provider Demographics
NPI:1184085516
Name:HESTER S PERNELL MD PLLC
Entity type:Organization
Organization Name:HESTER S PERNELL MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HESTER
Authorized Official - Middle Name:S
Authorized Official - Last Name:PERNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-281-3422
Mailing Address - Street 1:23077 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3709
Mailing Address - Country:US
Mailing Address - Phone:248-281-3422
Mailing Address - Fax:248-281-3211
Practice Address - Street 1:24628 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1905
Practice Address - Country:US
Practice Address - Phone:313-929-7379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-12
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI14798261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0630523Medicare UPIN