Individual
MARY ELLEN A HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1500 EAST MEDICAL CENTER DR, 8TH FLOOR C.S.MOTT CHILDRESN HOSPITAL, ANN ARBOR, MI 48109-4254
(734) 763-4109
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301030741
MI
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
4301030741
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1271106
—
MI
Enumeration date
08/08/2006
Last updated
08/08/2012
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