Provider Demographics
NPI:1679642540
Name:POULIOT, JOCELYN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:M
Last Name:POULIOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JOCELYN
Other - Middle Name:M
Other - Last Name:WESTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9415 TAYLORS TURN
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49346-8812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9415 TAYLORS TURN
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:MI
Practice Address - Zip Code:49346-8812
Practice Address - Country:US
Practice Address - Phone:231-834-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJP049722207R00000X
MI4301049722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4264320Medicaid
MI1750472734OtherGROUP NPI NUMBER
MI1101318392OtherBCBS
MI381916607OtherTAX ID
MI4264320Medicaid
MI381916607OtherTAX ID