Provider Demographics
NPI:1407985385
Name:FAMILY PHYSICIANS OF ST. JOSEPH, P.C.
Entity Type:Organization
Organization Name:FAMILY PHYSICIANS OF ST. JOSEPH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:PROOS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:269-429-5000
Mailing Address - Street 1:2500 NILES RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3237
Mailing Address - Country:US
Mailing Address - Phone:269-429-5000
Mailing Address - Fax:269-429-2598
Practice Address - Street 1:2500 NILES RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3237
Practice Address - Country:US
Practice Address - Phone:269-429-5000
Practice Address - Fax:269-429-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty