Provider Demographics
NPI:1073623252
Name:ANHALT, JOEL ELMER (DO)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ELMER
Last Name:ANHALT
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:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:MI
Mailing Address - Zip Code:49613-0337
Mailing Address - Country:US
Mailing Address - Phone:231-889-7030
Mailing Address - Fax:231-889-7032
Practice Address - Street 1:3618 GLOVERS LAKE RD
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:MI
Practice Address - Zip Code:49613-9744
Practice Address - Country:US
Practice Address - Phone:231-889-7030
Practice Address - Fax:231-889-7032
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015063207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4612281Medicaid
MII12303Medicare UPIN
MIN22060003Medicare ID - Type Unspecified