Provider Demographics
NPI:1023022902
Name:NERI, JOSEPH MARVYN (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MARVYN
Last Name:NERI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 HARRISON AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-1377
Mailing Address - Country:US
Mailing Address - Phone:906-643-8585
Mailing Address - Fax:906-643-9036
Practice Address - Street 1:220 BURDETTE ST
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781-1712
Practice Address - Country:US
Practice Address - Phone:906-643-8585
Practice Address - Fax:906-643-9036
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013054207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4310155Medicaid
OD96239031Medicare ID - Type Unspecified
MI4310155Medicaid