Provider Demographics
NPI:1770520926
Name:MAGNO, JOSE C (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:C
Last Name:MAGNO
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 1:5723 LONDONBERRIE CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6968
Mailing Address - Country:US
Mailing Address - Phone:989-837-8358
Mailing Address - Fax:
Practice Address - Street 1:1221 SOUTH DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3234
Practice Address - Country:US
Practice Address - Phone:989-772-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073241207P00000X
MI430107241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F71000OtherBCBSM
MI4409919Medicaid
MIJM073241OtherBLUE SHIELD
MI1770520926Medicaid
MIJM073241OtherBLUE SHIELD
MID33478Medicare UPIN
MI4409919Medicaid
MIM57650045Medicare UPIN