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General NPI Number Information
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NPI Number | 1154502243
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Entity Type | Organization
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Legal Business Name | JESUS ORTEGA, M.D., P.L.L.C.
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Dates
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Enumeration Date | 11/17/2007
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Last Update Date | 11/17/2007
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Provider Practice Location Address
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Address Line | 6760 ALLEN RD SUITE 106
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City | ALLEN PARK
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State | MI
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Zip | 48101-2078
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Country | US
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Telephone | 313-381-5522
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Fax | 313-381-2666
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Provider Business Mailing Address
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Address Line | 6760 ALLEN RD SUITE 106
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City | ALLEN PARK
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State | MI
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Zip | 48101-2078
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Country | US
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Telephone | 313-381-5522
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Fax | 313-381-2666
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Authorized Official
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Title or Position | OWNER
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Name | DR. JESUS ORTEGA
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Credential | MD
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Telephone | 313-381-5522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | JO4301031455
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License Number State | MI
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