1154502243 NPI number — JESUS ORTEGA, M.D., P.L.L.C.

Table of content: (NPI 1154502243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154502243 NPI number — JESUS ORTEGA, M.D., P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JESUS ORTEGA, M.D., P.L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154502243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6760 ALLEN RD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
ALLEN PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48101-2078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-381-5522
Provider Business Mailing Address Fax Number:
313-381-2666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6760 ALLEN RD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
ALLEN PARK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48101-2078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-381-5522
Provider Business Practice Location Address Fax Number:
313-381-2666
Provider Enumeration Date:
11/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ORTEGA
Authorized Official First Name:
JESUS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
313-381-5522

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  JO4301031455 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1130860001 . This is a "WELLNESS PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1457331704 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 110822641-1 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00124985 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: S19233 . This is a "OAKWOOD MANAGED CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0822641 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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