Provider Demographics
NPI:1205133857
Name:JUAN A. ESTIGARRIBIA MD. PC
Entity type:Organization
Organization Name:JUAN A. ESTIGARRIBIA MD. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESTIGARRIBIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-277-0075
Mailing Address - Street 1:23550 PARK ST., SUITE 201
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:313-277-0075
Mailing Address - Fax:313-277-8029
Practice Address - Street 1:23550 PARK ST., SUITE 201
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-277-0075
Practice Address - Fax:313-277-8029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038833291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDH1124OtherMEDICARE RAILROAD
MI110H244980OtherBCBSM
MI2021269 10Medicaid
MIR-12387506OtherFED BCBSM
MIDH1124OtherMEDICARE RAILROAD
MI110H244980OtherBCBSM