Provider Demographics
NPI:1760787428
Name:WILLIAM E JARVIS DPM P C
Entity Type:Organization
Organization Name:WILLIAM E JARVIS DPM P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-296-3680
Mailing Address - Street 1:19351 E 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-5308
Mailing Address - Country:US
Mailing Address - Phone:586-296-3680
Mailing Address - Fax:
Practice Address - Street 1:19351 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5308
Practice Address - Country:US
Practice Address - Phone:586-296-3680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000714213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5505002Medicare PIN
T97291Medicare UPIN