Provider Demographics
NPI:1184988685
Name:JUDGE, PAUL DANIEL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:DANIEL
Last Name:JUDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9045 US HIGHWAY 31 STE 3
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1804
Mailing Address - Country:US
Mailing Address - Phone:269-471-9702
Mailing Address - Fax:269-471-9707
Practice Address - Street 1:9045 US HIGHWAY 31 STE 3
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103
Practice Address - Country:US
Practice Address - Phone:269-471-9702
Practice Address - Fax:269-471-9707
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE6823207Y00000X
MI4301116557207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology