Provider Demographics
NPI:1316157993
Name:TORRES, VERONICA MOLINA (MD)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:MOLINA
Last Name:TORRES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA VERONICA LINDA
Other - Middle Name:MOLINA
Other - Last Name:EVANGELISTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4967 CROOKS RD
Mailing Address - Street 2:STE. 130
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-5801
Mailing Address - Country:US
Mailing Address - Phone:248-952-1601
Mailing Address - Fax:248-952-1614
Practice Address - Street 1:4967 CROOKS RD
Practice Address - Street 2:STE. 130
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-5801
Practice Address - Country:US
Practice Address - Phone:248-952-1601
Practice Address - Fax:248-952-1614
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088458208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1316157993Medicaid
MI70-0-F32947-0OtherBCBS CPIN #
MIP28070144Medicare PIN