Provider Demographics
NPI:1942212667
Name:MAROUS, JOSEPH J III (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:MAROUS
Suffix:III
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 1:605 W WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49440
Mailing Address - Country:US
Mailing Address - Phone:231-722-6005
Mailing Address - Fax:231-726-2804
Practice Address - Street 1:605 W WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440
Practice Address - Country:US
Practice Address - Phone:231-722-6005
Practice Address - Fax:231-726-2804
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010563682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00157198OtherRR MEDICARE
MI4661876100Medicaid
MI4661876100Medicaid
MIP00157198OtherRR MEDICARE