Provider Demographics
NPI:1083663314
Name:HAVILAND, JAMES E (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:HAVILAND
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3960 PATIENT CARE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4276
Mailing Address - Country:US
Mailing Address - Phone:517-372-7987
Mailing Address - Fax:517-372-7988
Practice Address - Street 1:3960 PATIENT CARE DR STE 101
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4276
Practice Address - Country:US
Practice Address - Phone:517-372-7987
Practice Address - Fax:517-372-7988
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2022-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301076189207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI180C911240OtherBCBSM
MI0830097OtherIBA/PHP
MI383309299006OtherTRICARE
MI7389543OtherAETNA
MIP00140569OtherRAILROAD MEDICARE
MI38330299093OtherCOMMUNTIY CHOICE
MI155536OtherGREAT LAKES HEALTH PLAN
MI4604913Medicaid
MI135840000OtherDEPARTMENT OF LABOR
MI155536OtherGREAT LAKES HEALTH PLAN
MI0N91680001Medicare PIN