Provider Demographics
NPI:1578531232
Name:JOSEPH, JAPHET G (MD)
Entity Type:Individual
Prefix:
First Name:JAPHET
Middle Name:G
Last Name:JOSEPH
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 1:714 S TRUMBULL ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-4217
Mailing Address - Country:US
Mailing Address - Phone:989-892-8456
Mailing Address - Fax:989-892-4692
Practice Address - Street 1:714 S TRUMBULL ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-4217
Practice Address - Country:US
Practice Address - Phone:989-892-8456
Practice Address - Fax:989-892-4692
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI041386207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1801113923OtherNPI GROUP NUMBER
MI0600901611OtherBCBS ID NUMBER
MI4347610Medicaid
MI4347610Medicaid
MION38580Medicare ID - Type Unspecified