Provider Demographics
NPI:1205921251
Name:HORWICH, JAY PHILLIP (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:PHILLIP
Last Name:HORWICH
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 1:52375 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-9332
Mailing Address - Country:US
Mailing Address - Phone:269-668-6282
Mailing Address - Fax:
Practice Address - Street 1:52375 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49071-9332
Practice Address - Country:US
Practice Address - Phone:269-668-6282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071215207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4273641Medicaid
MI4273641Medicaid
MID93862Medicare UPIN