Provider Demographics
NPI:1518414838
Name:SHREVE, JOEL EMMANUEL-PIERRE JR
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:EMMANUEL-PIERRE
Last Name:SHREVE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 BURT RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1258
Mailing Address - Country:US
Mailing Address - Phone:313-273-2068
Mailing Address - Fax:
Practice Address - Street 1:11300 BURT RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1258
Practice Address - Country:US
Practice Address - Phone:313-273-2068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIS610425229352247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other