Antonio Delara M.D., P.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

AD048423 Issued in MI

Legal business name

ANTONIO DELARA M.D., P.C.

Practice address

1611 Monroe St
Dearborn, MI 48124-2912

Phone

(313) 278-7100

Fax

(313) 562-2216

NPI assigned

Nov 12, 2007

Last updated

Nov 13, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Antonio Fernandez Delara, M.D.

Title

Owner

Phone

(313) 562-3832

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1770763310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 MONROE ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242912",
            "telephone_number": "313-278-7100",
            "fax_number": "313-562-2216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 MONROE ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242912",
            "telephone_number": "313-278-7100",
            "fax_number": "313-562-2216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTONIO DELARA M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-12",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "DELARA",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_middle_name": "FERNANDEZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-562-3832",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "AD048423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "1108225362",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "P47900",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENCE",
            "identifier": "AD048423",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4596660",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5605727",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.