Individual
MARIDEL AILEEN HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
19603 E 8 MILE RD, SAINT CLAIR SHORES, MI 48080-1655
(586) 445-7900
(586) 445-7940
Mailing address
19603 E 8 MILE RD, SAINT CLAIR SHORES, MI 48080-1655
(586) 445-7900
(586) 445-7940
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5101012021
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E02258
BCBS PIN
MI
01
—
1158213464
BCBS OF MI
MI
05
—
4869383
—
MI
Enumeration date
06/17/2005
Last updated
10/19/2009
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