Healthcare Provider Details

I. General information

NPI: 1801839899
Provider Name (Legal Business Name): ERNESTO R DRELICHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16001 W 9 MILE RD 3RD FLOOR FISHER
SOUTHFIELD MI
48075-4818
US

IV. Provider business mailing address

16001 W 9 MILE RD 3RD FLOOR FISHER
SOUTHFIELD MI
48075-4818
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-6030
  • Fax:
Mailing address:
  • Phone: 248-849-6030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number26148
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: