Provider Demographics
NPI:1255337689
Name:ENGEL, JOEL C (DO)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:C
Last Name:ENGEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18303 E 10 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4988
Mailing Address - Country:US
Mailing Address - Phone:586-776-8877
Mailing Address - Fax:586-776-3092
Practice Address - Street 1:18303 E 10 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4988
Practice Address - Country:US
Practice Address - Phone:586-776-8877
Practice Address - Fax:586-776-3092
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2012-06-06
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
MI8340207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2678972Medicaid
MI5500077OtherBLUE CROSS
MI5500077Medicare PIN
MI5500077OtherBLUE CROSS