Provider Demographics
NPI:1720110463
Name:SAENZ, ADELITA (MD)
Entity Type:Individual
Prefix:
First Name:ADELITA
Middle Name:
Last Name:SAENZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADELITA
Other - Middle Name:
Other - Last Name:ALCALA-SAENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2009 HOLTON RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-1578
Practice Address - Country:US
Practice Address - Phone:231-291-8399
Practice Address - Fax:231-291-8397
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060189207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN28430081Medicare PIN