Provider Demographics
NPI:1447241716
Name:FAILLA, JOSEPH MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:FAILLA
Suffix:
Gender:M
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:PO BOX 523
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49429-0523
Mailing Address - Country:US
Mailing Address - Phone:616-457-4919
Mailing Address - Fax:616-457-5261
Practice Address - Street 1:29829 TELEGRAPH RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1330
Practice Address - Country:US
Practice Address - Phone:248-352-4263
Practice Address - Fax:248-352-2915
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010563082086S0105X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4579089Medicaid
MI540F324290OtherBCBS DME PIN
MI4579089Medicaid
MI540F324290OtherBCBS DME PIN
MIP35120133Medicare PIN
MIN84480001Medicare PIN
MI5222850001Medicare NSC