Provider Demographics
NPI:1093701203
Name:MORIN, JEFFREY R (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:MORIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 RIVER CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-4463
Mailing Address - Country:US
Mailing Address - Phone:810-985-4900
Mailing Address - Fax:810-985-3634
Practice Address - Street 1:4660 S HAGADORN RD
Practice Address - Street 2:STE 500
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5353
Practice Address - Country:US
Practice Address - Phone:517-884-4554
Practice Address - Fax:517-884-4556
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM005697213E00000X
MI5901002026213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1093701203Medicaid
MI4317700Medicaid
MI4317700Medicaid
MI0P23290006Medicare PIN
MI0N30730Medicare PIN