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NPI Code Detail

MEDICARE: EUSEBIO GUILLERMO HERNANDEZ M.D.

MEDICARE: EUSEBIO GUILLERMO HERNANDEZ M.D.
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
12084P0800XPsychiatry Physician69827-20WI
22084P0800XPsychiatry Physician4301110668MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184790503
Entity Type Code : Individual
Provider Name (Legal Business Name) : EUSEBIO GUILLERMO HERNANDEZ M.D.
Provider Business Mailing Address
First Line : 5635 W FORT ST
Second Line :
City : DETROIT
State : MI
Zip : 48209-3154
Country : US
Telephone Number : 313-849-3920
Fax Number : 313-849-0824
Provider Business Practice Location Address
First Line : 5635 W FORT ST
Second Line :
City : DETROIT
State : MI
Zip : 48209-3154
Country : US
Telephone Number : 313-849-3920
Fax Number : 313-849-0824
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2006
Last Update Date : 10/26/2020

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