Provider Demographics
NPI:1659522324
Name:DEWITT, JOSEPH EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:DEWITT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:4600 S HAGADORN RD
Practice Address - Street 2:#500
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5306
Practice Address - Country:US
Practice Address - Phone:517-884-4554
Practice Address - Fax:517-884-4556
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS014230207X00000X
MI5101019945207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1659522324Medicaid
MI0C36082157Medicare PIN