Provider Demographics
NPI:1083625032
Name:SPOHN, EARLE W JR (DO)
Entity Type:Individual
Prefix:MR
First Name:EARLE
Middle Name:W
Last Name:SPOHN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:27 BALFOUR DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304
Mailing Address - Country:US
Mailing Address - Phone:248-646-8411
Mailing Address - Fax:248-646-2296
Practice Address - Street 1:7815 EAST JEFFERSON
Practice Address - Street 2:SUITE 3D
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214
Practice Address - Country:US
Practice Address - Phone:313-499-4862
Practice Address - Fax:313-499-4865
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101005851208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0288229095OtherBCBS
MI1561975Medicaid
MI8822909OtherBCBS
8822909Medicare ID - Type Unspecified
MI2762001Medicare PIN
MI8822909OtherBCBS