Provider Demographics
NPI:1811023948
Name:HUBACHER-GADZINSKI, JOSLYN
Entity Type:Individual
Prefix:
First Name:JOSLYN
Middle Name:
Last Name:HUBACHER-GADZINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOSLYN
Other - Middle Name:MARIE
Other - Last Name:HUBACHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:126 W LUDINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2022
Mailing Address - Country:US
Mailing Address - Phone:231-845-1215
Mailing Address - Fax:
Practice Address - Street 1:126 W LUDINGTON AVE
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2022
Practice Address - Country:US
Practice Address - Phone:231-845-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007362207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI085531347OtherBC INDIVIDUAL
MI0E36001002OtherBC PPI