Provider Demographics
NPI:1720026735
Name:PAHN, JAAK MART (MD)
Entity Type:Individual
Prefix:
First Name:JAAK
Middle Name:MART
Last Name:PAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:550 OSBORN BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1899
Mailing Address - Country:US
Mailing Address - Phone:906-632-0370
Mailing Address - Fax:906-632-2081
Practice Address - Street 1:550 OSBORN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1899
Practice Address - Country:US
Practice Address - Phone:906-632-0370
Practice Address - Fax:906-632-2081
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-02-20
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Provider Licenses
StateLicense IDTaxonomies
MIJP043613207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4667593Medicaid
MI4667593Medicaid
MI233906Medicare Oscar/Certification
0170005Medicare ID - Type Unspecified