Provider Demographics
NPI:1871980953
Name:OTERO-LOPERENA, EDUARDO JOSE (MD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:JOSE
Last Name:OTERO-LOPERENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2545 CAPITAL AVE SW STE 201A
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-7103
Mailing Address - Country:US
Mailing Address - Phone:269-883-2495
Mailing Address - Fax:269-224-6185
Practice Address - Street 1:13530 MICHIGAN AVE STE 110
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3575
Practice Address - Country:US
Practice Address - Phone:313-572-0810
Practice Address - Fax:313-572-0811
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301504574208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty