Provider Demographics
NPI:1528012366
Name:BEHM, JOHN ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:BEHM
Suffix:
Gender:M
Credentials:DO
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 519
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-0519
Mailing Address - Country:US
Mailing Address - Phone:989-729-7779
Mailing Address - Fax:979-729-7313
Practice Address - Street 1:6980 S M 52
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9515
Practice Address - Country:US
Practice Address - Phone:989-729-7779
Practice Address - Fax:989-729-7313
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJB011045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4472180Medicaid
MI5080083OtherAETNA
MI01-70825Medicaid
MI0857800074OtherBCBSM PROVIDER ID
MI0986795OtherHEALTH PLUS
MI0857800074OtherBCN
MI785498OtherFIRST HEALTH
MI01-00825OtherPHP
MI4472180Medicaid
MI0986795OtherHEALTH PLUS
MI5080083OtherAETNA