1487868121 NPI number — MRS. HILDA C. FERRARER-BLAIR M.D.

Table of content: MRS. HILDA C. FERRARER-BLAIR M.D. (NPI 1487868121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487868121 NPI number — MRS. HILDA C. FERRARER-BLAIR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRARER-BLAIR
Provider First Name:
HILDA
Provider Middle Name:
C.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FERRARER
Provider Other First Name:
HILDA
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1487868121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80650 VAN DYKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRUCE TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48065-1333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-798-6410
Provider Business Mailing Address Fax Number:
810-798-6419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80650 VAN DYKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUCE TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48065-1333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-798-6410
Provider Business Practice Location Address Fax Number:
810-798-6419
Provider Enumeration Date:
05/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  046970 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 4301085592 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 019285 . This is a "KAISER COMMERCIAL NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 97538841 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".