Provider Demographics
NPI:1962863548
Name:JBC MDVIP PC
Entity type:Organization
Organization Name:JBC MDVIP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CALADO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-606-4190
Mailing Address - Street 1:1639 E BIG BEAVER RD STE 202
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2054
Mailing Address - Country:US
Mailing Address - Phone:248-606-4190
Mailing Address - Fax:248-598-5088
Practice Address - Street 1:1639 E BIG BEAVER RD STE 202
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2054
Practice Address - Country:US
Practice Address - Phone:248-606-4190
Practice Address - Fax:248-598-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012319207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty