MEDICARE: EDUARDO JOSE OTERO-LOPERENA MD

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	208100000X	Physical Medicine & Rehabilitation Physician	4301504574	MI

General Provider Information

NPI Number	:	1871980953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDUARDO JOSE OTERO-LOPERENA MD

Provider Business Mailing Address
First Line	:	2545 CAPITAL AVE SW STE 201A
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49015-7103
Country	:	US
Telephone Number	:	269-883-2495
Fax Number	:	269-224-6185

Provider Business Practice Location Address
First Line	:	13530 MICHIGAN AVE STE 110
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-3575
Country	:	US
Telephone Number	:	313-572-0810
Fax Number	:	313-572-0811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2015
Last Update Date	:	05/15/2024

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