Provider Demographics
NPI:1861500670
Name:MAESAKA, JOHN FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANCIS
Last Name:MAESAKA
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 1:15730 COUNTY ROAD 28
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-9670
Mailing Address - Country:US
Mailing Address - Phone:574-534-5515
Mailing Address - Fax:574-533-2413
Practice Address - Street 1:15730 COUNTY ROAD 28
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-9670
Practice Address - Country:US
Practice Address - Phone:574-534-5515
Practice Address - Fax:574-533-2413
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010522092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI300A710390OtherBCBS GROUP#
MI0A76002Medicare ID - Type UnspecifiedGROUP #
E89508Medicare UPIN