Provider Demographics
NPI:1578887535
Name:EARLE W. SPOHN JR. D.O. P.C.
Entity Type:Organization
Organization Name:EARLE W. SPOHN JR. D.O. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EARLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:SPOHN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:248-646-8411
Mailing Address - Street 1:27 BALFOUR DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304
Mailing Address - Country:US
Mailing Address - Phone:248-646-8411
Mailing Address - Fax:248-646-2296
Practice Address - Street 1:27 BALFOUR DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304
Practice Address - Country:US
Practice Address - Phone:248-646-8411
Practice Address - Fax:248-646-2296
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EARLE W. SPOHN JR. D.O.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-19
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005851208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0258217514OtherBCBS
MI1561975Medicaid
E37565Medicare UPIN
MI8822909Medicare PIN
MIMI2762Medicare PIN