Provider Demographics
NPI:1134101959
Name:JOSEPH, JASMINE (MD)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 DEPT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-0021
Mailing Address - Country:US
Mailing Address - Phone:906-225-3910
Mailing Address - Fax:906-225-4529
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:STE 344
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-225-3910
Practice Address - Fax:906-225-4529
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI062693207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3138375Medicaid
MI110095654OtherRAILROAD MEDICARE
MI381358036011OtherTRICARE
MI0M03300005Medicare PIN
F88734Medicare UPIN