Provider Demographics
NPI:1790908861
Name:TERRIAN, JAMES CLEMENT (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLEMENT
Last Name:TERRIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14344 S COOPER ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:MI
Mailing Address - Zip Code:49868-1920
Mailing Address - Country:US
Mailing Address - Phone:906-293-5756
Mailing Address - Fax:
Practice Address - Street 1:14150 COUNTY ROAD 428
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:MI
Practice Address - Zip Code:49868-7762
Practice Address - Country:US
Practice Address - Phone:906-293-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010301012083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5100591Medicaid
MI1891460Medicaid
MI2789120Medicaid
MI2789130Medicaid
MI5100608Medicaid
MI1498334Medicaid
MI1850341Medicaid
MI2789149Medicaid
MI5100573Medicaid
MI5100582Medicaid
MIF18651Medicare UPIN
MI5100573Medicaid
MI5100608Medicaid