Individual
DR. FIDELINA NITURA BARACEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
43750 WOODWARD AVE, STE 104, BLOOMFIELD HILLS, MI 48302-5063
(248) 334-6000
(248) 334-8740
Mailing address
43750 WOODWARD AVE, STE 104, BLOOMFIELD HILLS, MI 48302-5063
(248) 334-6000
(248) 334-8740
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
FB035468
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101152
MERCY HEALTH PLAN ID #
MI
05
—
195380310
—
MI
01
—
3506341231
BCBS PROV ID #
MI
01
—
FB035468
STATE LIC NUMBER
MI
Enumeration date
06/15/2006
Last updated
03/21/2017
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