MEDICARE: HESTER S PERNELL MD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	MI14798	MI

General Provider Information

NPI Number	:	1184085516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HESTER S PERNELL MD PLLC

Provider Business Mailing Address
First Line	:	23077 GREENFIELD RD
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-3709
Country	:	US
Telephone Number	:	248-281-3422
Fax Number	:	248-281-3211

Provider Business Practice Location Address
First Line	:	24628 RIDGEVIEW DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-1905
Country	:	US
Telephone Number	:	313-929-7379
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. HESTER S PERNELL
Credential	:	MD
Telephone Number	:	248-281-3422

Provider Enumeration Date	:	03/12/2016
Last Update Date	:	03/12/2016

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