Provider Demographics
NPI:1649238098
Name:BIANCALANA, FLORA ERMENIA (MD)
Entity type:Individual
Prefix:DR
First Name:FLORA
Middle Name:ERMENIA
Last Name:BIANCALANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3189 LOGAN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4772
Mailing Address - Country:US
Mailing Address - Phone:231-932-1988
Mailing Address - Fax:231-932-7693
Practice Address - Street 1:3189 LOGAN VALLEY RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4772
Practice Address - Country:US
Practice Address - Phone:231-932-1988
Practice Address - Fax:231-932-7693
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1649238098Medicaid
MI429144310Medicaid
MIH36352Medicare UPIN
MI429144310Medicaid