Provider Demographics
NPI:1013167170
Name:JOSEPH, LOUIS THEODORE (MD,)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:THEODORE
Last Name:JOSEPH
Suffix:
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 1:302 E LAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-2902
Mailing Address - Country:US
Mailing Address - Phone:248-881-6763
Mailing Address - Fax:321-441-9757
Practice Address - Street 1:302 E LAKEWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405
Practice Address - Country:US
Practice Address - Phone:321-289-9821
Practice Address - Fax:321-441-9757
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0386402084P0800X
MI43010998982084P0800X
FLME1218262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013883800Medicaid
FL013883800Medicaid