Organization
MARIDEL HERNANDEZ INTERNAL MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIDEL HERNANDEZ D.O. (OWNER CEO)
(313) 640-8400
Entity
Organization
Contact information
Practice address
131 KERCHEVAL AVE, SUITE 120, GROSSE POINTE FARMS, MI 48236-3629
(313) 640-8400
(313) 640-9232
Mailing address
131 KERCHEVAL AVE, SUITE 120, GROSSE POINTE FARMS, MI 48236-3629
(313) 640-8400
(313) 640-9232
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
BLUE CROSS BLUE SHIELD
MI
05
—
4869383-11
—
MI
Enumeration date
10/25/2006
Last updated
01/12/2011
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