Provider Demographics
NPI:1497706410
Name:PAEZ GONZALEZ, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:PAEZ GONZALEZ
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 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:4444 W BRISTOL RD
Practice Address - Street 2:STE. 150
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3153
Practice Address - Country:US
Practice Address - Phone:810-230-9500
Practice Address - Fax:810-230-0169
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4374958Medicaid
MIC77525Medicare UPIN
MIM40150009Medicare ID - Type Unspecified