Provider Demographics
NPI:1073607909
Name:JOSEPH, MICHAEL HENRY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HENRY
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3982 POWELL RD
Mailing Address - Street 2:SUITE 271
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7662
Mailing Address - Country:US
Mailing Address - Phone:614-889-6422
Mailing Address - Fax:614-453-8863
Practice Address - Street 1:5060 BRADENTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3511
Practice Address - Country:US
Practice Address - Phone:614-889-6422
Practice Address - Fax:614-453-8863
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35090663208000000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2786310Medicaid
OH2786310Medicaid