Provider Demographics
NPI:1760610455
Name:DEJONG, JOYCE (DO)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:DEJONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-2199
Mailing Address - Country:US
Mailing Address - Phone:517-364-2578
Mailing Address - Fax:
Practice Address - Street 1:1322 E MICHIGAN AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2199
Practice Address - Country:US
Practice Address - Phone:517-364-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010300207ZF0201X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology