Provider Demographics
NPI:1861508830
Name:JARVIS, WILLIAM EUGENE (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EUGENE
Last Name:JARVIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36325 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2958
Mailing Address - Country:US
Mailing Address - Phone:586-791-2900
Mailing Address - Fax:
Practice Address - Street 1:36325 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-2958
Practice Address - Country:US
Practice Address - Phone:586-791-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWJ000714213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1092464Medicaid
MI1092464Medicaid
T97291Medicare UPIN