Provider Demographics
NPI:1962711549
Name:CESAR D HIDALGO MD PC
Entity type:Organization
Organization Name:CESAR D HIDALGO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:DIAZ
Authorized Official - Last Name:HIDALGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-852-1777
Mailing Address - Street 1:595 BARCLAY CIR
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5802
Mailing Address - Country:US
Mailing Address - Phone:248-852-1777
Mailing Address - Fax:248-852-5001
Practice Address - Street 1:595 BARCLAY CIR
Practice Address - Street 2:SUITE C
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5802
Practice Address - Country:US
Practice Address - Phone:248-852-1777
Practice Address - Fax:248-852-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039585174400000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB43455Medicare UPIN
MI0631859Medicare PIN