Provider Demographics
NPI:1952324642
Name:PEASE, JOANNA R
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:R
Last Name:PEASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25531 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-1413
Mailing Address - Country:US
Mailing Address - Phone:586-757-9707
Mailing Address - Fax:586-757-9808
Practice Address - Street 1:25531 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1413
Practice Address - Country:US
Practice Address - Phone:586-757-9707
Practice Address - Fax:586-757-9808
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008372207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N65730Medicare ID - Type UnspecifiedMEDICARE
F02040Medicare UPIN