Provider Demographics
NPI:1699774133
Name:CORDOBA-NAGUIT, MARIA ADELA A (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA ADELA
Middle Name:A
Last Name:CORDOBA-NAGUIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 E CUMMINS ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-2074
Mailing Address - Country:US
Mailing Address - Phone:517-423-5508
Mailing Address - Fax:517-423-4772
Practice Address - Street 1:502 E CUMMINS ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-2074
Practice Address - Country:US
Practice Address - Phone:517-423-5508
Practice Address - Fax:517-423-4772
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0804610351OtherBCBS
MI03680OtherPARAMOUNT
G98015Medicare UPIN
0804610351OtherBCBS