Provider Demographics
NPI:1902851173
Name:MAINO, JOHN C II (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:MAINO
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:DEPARTMENT 272801
Mailing Address - Street 2:PO BOX 67000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-2728
Mailing Address - Country:US
Mailing Address - Phone:517-841-6913
Mailing Address - Fax:517-841-6917
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-788-4800
Practice Address - Fax:517-780-9630
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301042724207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM88560011Medicare ID - Type UnspecifiedWA FOOTE MEMORIAL
MIF22535Medicare UPIN