Provider Demographics
NPI:1972657260
Name:JOE, LONNIE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:
Last Name:JOE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22255 GREENFIELD RD
Mailing Address - Street 2:STE 280
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3712
Mailing Address - Country:US
Mailing Address - Phone:248-557-5227
Mailing Address - Fax:248-557-1732
Practice Address - Street 1:22255 GREENFIELD RD
Practice Address - Street 2:STE 280
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3712
Practice Address - Country:US
Practice Address - Phone:248-557-5227
Practice Address - Fax:248-557-1732
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MILJ041569207RP1001X
MI4301041569207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382494448OtherTAX ID
MI1490579Medicaid
MI1106317218OtherBLUE CROSS BLUE SHIELD
MI1106317218OtherBLUE CROSS BLUE SHIELD
MI1490579Medicaid