Provider Demographics
NPI:1609871037
Name:GONZALEZ, JOSEPH VINCENT (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:VINCENT
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:2843 E GRAND RIVER AVE
Mailing Address - Street 2:# 235
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6722
Mailing Address - Country:US
Mailing Address - Phone:517-853-8951
Mailing Address - Fax:517-913-5996
Practice Address - Street 1:2270 JOLLY OAK RD
Practice Address - Street 2:STE 1
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-4528
Practice Address - Country:US
Practice Address - Phone:517-853-8951
Practice Address - Fax:517-913-5996
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2008-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5901002023213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4892840001Medicare NSC