Provider Demographics
NPI:1326084013
Name:MOSSEL, JEFFREY R (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:MOSSEL
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 1:103 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1745
Mailing Address - Country:US
Mailing Address - Phone:231-796-4522
Mailing Address - Fax:231-796-9516
Practice Address - Street 1:103 S STATE ST
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1745
Practice Address - Country:US
Practice Address - Phone:231-796-4522
Practice Address - Fax:231-796-9516
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002101213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4423471Medicaid
MIU92049Medicare UPIN
MI4667100001Medicare NSC
MI480034727Medicare PIN
MI4423471Medicaid