Provider Demographics
NPI:1659605582
Name:JOSE, JINSON (MD)
Entity Type:Individual
Prefix:
First Name:JINSON
Middle Name:
Last Name:JOSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1349 S ROCHESTER RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3150
Mailing Address - Country:US
Mailing Address - Phone:248-759-4852
Mailing Address - Fax:248-299-9860
Practice Address - Street 1:1349 S ROCHESTER RD
Practice Address - Street 2:SUITE 115
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3150
Practice Address - Country:US
Practice Address - Phone:248-759-4852
Practice Address - Fax:248-299-9860
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301085938207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F32901OtherBCBS OF MICHIGAN
MI1659605582Medicaid
MI0P023670Medicare PIN