Basic Information
Provider Information
NPI: 1174564827
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TORRES
FirstName: MIRIAM
MiddleName: ESTHER
NamePrefix: DR.
NameSuffix: I
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1239
Address2:  
City: TROY
State: MI
PostalCode: 480991239
CountryCode: US
TelephoneNumber: 2488246600
FaxNumber: 2483241477
Practice Location
Address1: 1484 STRAITS DR
Address2: SUITE 5
City: BAY CITY
State: MI
PostalCode: 487068718
CountryCode: US
TelephoneNumber: 9896678740
FaxNumber: 9896678745
Other Information
ProviderEnumerationDate: 06/10/2006
LastUpdateDate: 04/18/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X7748PRY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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