Provider Demographics
NPI:1245235654
Name:JARAD, JOHN IMAD (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:IMAD
Last Name:JARAD
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 1:2540 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6405
Mailing Address - Country:US
Mailing Address - Phone:810-987-1000
Mailing Address - Fax:810-982-1810
Practice Address - Street 1:2540 16TH ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6405
Practice Address - Country:US
Practice Address - Phone:810-987-1000
Practice Address - Fax:810-982-1810
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI061093207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0994185OtherHEALTHPLUS
MIG35455OtherHAP/CIGNA
MI0P225700002OtherMEDICARE PROVIDER PIN
MI105910404081OtherHUMANA
MI2366756OtherAETNA MEDICARE ADVANTAGE
MIDG3605OtherRAILROAD MEDICARE GROUP PIN
MIG35455OtherALLIANCE HEALTH PLAN
MI1417675OtherUNITED HEALTH CARE
MI900040508OtherPRIORITY HEALTH
MI110196407OtherRAILROAD MEDICARE PROVIDER PIN
MI1107401082OtherBCBSM
MI1107401082OtherMEDICARE PLUS BLUE
MI4152744Medicaid
MI2366756OtherAETNA MEDICARE ADVANTAGE
MIDG3605OtherRAILROAD MEDICARE GROUP PIN
MI1107401082OtherMEDICARE PLUS BLUE
MIDG3605OtherRAILROAD MEDICARE GROUP PIN
MI110196407OtherRAILROAD MEDICARE PROVIDER PIN