Provider Demographics
NPI:1124120860
Name:JOTA, JOSE M (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:JOTA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5232 RICHFIELD RD
Mailing Address - Street 2:STE B
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-2182
Mailing Address - Country:US
Mailing Address - Phone:810-736-0740
Mailing Address - Fax:810-736-1221
Practice Address - Street 1:5232 RICHFIELD RD
Practice Address - Street 2:SUITE B
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-2161
Practice Address - Country:US
Practice Address - Phone:810-736-0740
Practice Address - Fax:810-736-1221
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-10-30
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Provider Licenses
StateLicense IDTaxonomies
MI4301066444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4773513Medicaid
MI4773513Medicaid
MIM23560111Medicare PIN