Provider Demographics
NPI:1063496347
Name:FERMIL, FLORANTE (MD)
Entity type:Individual
Prefix:DR
First Name:FLORANTE
Middle Name:
Last Name:FERMIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 S ROCHESTER RD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5160
Mailing Address - Country:US
Mailing Address - Phone:248-844-6000
Mailing Address - Fax:248-844-6159
Practice Address - Street 1:3950 S ROCHESTER RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5160
Practice Address - Country:US
Practice Address - Phone:248-844-6000
Practice Address - Fax:248-844-6159
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0633408OtherBCBS INDIVIDUAL
MIG08719OtherHAP
MI1063496347Medicaid
MI700H217350OtherBLUE SHIELD
MIG08719OtherHAP
G08719Medicare UPIN