Healthcare Provider Details

I. General information

NPI: 1699774133
Provider Name (Legal Business Name): MARIA ADELA A. CORDOBA-NAGUIT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E CUMMINS ST
TECUMSEH MI
49286-2074
US

IV. Provider business mailing address

502 E CUMMINS ST
TECUMSEH MI
49286-2074
US

V. Phone/Fax

Practice location:
  • Phone: 517-423-5508
  • Fax: 517-423-4772
Mailing address:
  • Phone: 517-423-5508
  • Fax: 517-423-4772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301073146
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: