Organization
ANTONIO DELARA M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTONIO FERNANDEZ DELARA M.D. (OWNER)
(313) 562-3832
Entity
Organization
Contact information
Practice address
1611 MONROE ST, DEARBORN, MI 48124-2912
(313) 278-7100
(313) 562-2216
Mailing address
1611 MONROE ST, DEARBORN, MI 48124-2912
(313) 278-7100
(313) 562-2216
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
AD048423
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1108225362
BCBSM
MI
05
—
4596660
—
MI
01
—
5605727
CIGNA
MI
01
—
AD048423
STATE LICENCE
MI
01
—
P47900
BCN
MI
Enumeration date
11/12/2007
Last updated
11/13/2007
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