Provider Demographics
NPI:1508861659
Name:ERNEST, PAUL H (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:H
Last Name:ERNEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:850 W NORTH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3196
Mailing Address - Country:US
Mailing Address - Phone:517-841-3022
Mailing Address - Fax:517-817-0144
Practice Address - Street 1:1116 W GANSON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4240
Practice Address - Country:US
Practice Address - Phone:517-782-9436
Practice Address - Fax:517-782-5166
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301034151207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI180F373640OtherBCBSM
MI3037757Medicaid
MI180C846310OtherBCBSM
MI180H149970OtherBCBSM
MI3286304Medicaid
180019352OtherRAILROAD MEDICARE
MI3229602Medicaid
MI180C846310OtherBCBSM
MI180F373640OtherBCBSM
MI3229602Medicaid