Provider Demographics
NPI:1225293905
Name:MOSES, JUANITA PREMA (MD)
Entity Type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:PREMA
Last Name:MOSES
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:117 W PATERSON ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-2557
Mailing Address - Country:US
Mailing Address - Phone:269-349-2641
Mailing Address - Fax:269-201-2855
Practice Address - Street 1:7070 E DR N
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-8562
Practice Address - Country:US
Practice Address - Phone:269-660-1670
Practice Address - Fax:269-660-0666
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2022-12-27
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Provider Licenses
StateLicense IDTaxonomies
MI4301072595208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM97310014Medicare PIN