Provider Demographics
NPI:1063469989
Name:FALK, JERROLD S (MD)
Entity Type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:S
Last Name:FALK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M302
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-276-0000
Mailing Address - Fax:269-276-0001
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M302
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-276-0000
Practice Address - Fax:269-276-0001
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI036491207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI036491OtherMEDICAL LICENSE NUMBER
MI1103911681OtherBLUE CROSS BLUE SHIELD
MIB46599Medicare UPIN
MI394912Medicare ID - Type Unspecified
MI1103911681OtherBLUE CROSS BLUE SHIELD