Provider Demographics
NPI:1285690255
Name:FARRELL, JOSEPH PETER (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PETER
Last Name:FARRELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT 272801
Mailing Address - Street 2:PO BOX 67000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-2728
Mailing Address - Country:US
Mailing Address - Phone:517-841-6913
Mailing Address - Fax:517-841-6917
Practice Address - Street 1:110 N ELM AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3571
Practice Address - Country:US
Practice Address - Phone:517-788-6760
Practice Address - Fax:517-788-3029
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.007479207P00000X
MI5101015920207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4728554Medicaid
MIP00237166OtherRR MEDICARE
MI4728554Medicaid
MIH54446Medicare UPIN