Provider Demographics
NPI:1629034020
Name:MESSINA, JOSEPH FRANK (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:FRANK
Last Name:MESSINA
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 869
Mailing Address - Street 2:
Mailing Address - City:ISLE OF PALMS
Mailing Address - State:SC
Mailing Address - Zip Code:29451-0869
Mailing Address - Country:US
Mailing Address - Phone:888-264-6330
Mailing Address - Fax:888-264-6335
Practice Address - Street 1:4075 COPPER RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:888-632-0545
Practice Address - Fax:231-932-4137
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC796207R00000X
NY223291207R00000X
NC2010-00411208M00000X
GA066870208M00000X
ARE-8804208M00000X
OH011386208M00000X
IN02004518A208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT0576Medicaid
OH0134562Medicaid
WV1629034020Medicaid
SCT0576Medicaid
OH0134562Medicaid