Individual
IMELDA E DE VERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 898-5000
Mailing address
1719 W BIG BEAVER RD, TROY, MI 48084-3510
(248) 458-0400
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
5101018657
MI
Other
Enumeration date
03/25/2010
Last updated
07/30/2015
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