Provider Demographics
NPI:1083677371
Name:PODD, JOSEPH EDWARD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:PODD
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:5301 E HURON RIVER DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1051
Mailing Address - Country:US
Mailing Address - Phone:734-712-5609
Mailing Address - Fax:734-712-5797
Practice Address - Street 1:5301 E HURON RIVER DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1051
Practice Address - Country:US
Practice Address - Phone:734-712-5609
Practice Address - Fax:734-712-5797
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-09
Last Update Date:2014-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001374363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical